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General NPI Number Information
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NPI Number | 1083721732
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Entity Type | Organization
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Legal Business Name | SOUTHERN HEALTH CORP. OF HOUSTON, INC
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Dates
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Enumeration Date | 08/25/2006
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Last Update Date | 01/18/2024
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Provider Practice Location Address
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Address Line | 1002 E MADISON ST STE 2
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City | HOUSTON
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State | MS
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Zip | 38851-2428
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Country | US
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Telephone | 662-456-5008
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Fax | 662-456-5404
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Provider Business Mailing Address
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Address Line | PO BOX 432
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City | HOUSTON
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State | MS
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Zip | 38851-0432
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Country | US
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Telephone | 662-456-5008
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Fax | 662-456-5404
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Authorized Official
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Title or Position | CEO
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Name | MS. SHEILA BROCKMAN
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Credential |
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Telephone | 662-456-3700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | 12-296
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License Number State | MS
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