MEDICARE: SOUTHERN HEALTH CORP OF HOUSTON, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282N00000X	General Acute Care Hospital	12296	MS

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C 02044	OTHER	MS	MEDICARE / CAHABA
2	C02335	OTHER	MS	MEDICARE / CAHABA
6	C00717	OTHER	MS	MEDICARE / CAHABA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	000020031	OTHER	BC
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366465502
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN HEALTH CORP OF HOUSTON, INC.

Provider Business Mailing Address
First Line	:	PO BOX 626
Second Line	:
City	:	HOUSTON
State	:	MS
Zip	:	38851
Country	:	US
Telephone Number	:	662-456-3701
Fax Number	:	662-456-1083

Provider Business Practice Location Address
First Line	:	1002 E MADISON ST
Second Line	:
City	:	HOUSTON
State	:	MS
Zip	:	38851-2428
Country	:	US
Telephone Number	:	662-456-3700
Fax Number	:	662-456-1083

Authorized Official
Title or Position	:	CEO
Name	:	MS. SHEILA BROCKMAN
Credential	:
Telephone Number	:	662-456-3700

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	01/18/2024

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Directions to “SOUTHERN HEALTH CORP OF HOUSTON, INC. ” Practice Location

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