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	261QR1300X	Rural Health Clinic/Center	12-296	MS

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	C02044	OTHER	MS	MEDICARE PART B GROUP

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	253422	OTHER	MS	TRISPAN

General Provider Information

NPI Number	:	1083721732
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN HEALTH CORP. OF HOUSTON, INC

Provider Business Mailing Address
First Line	:	PO BOX 432
Second Line	:
City	:	HOUSTON
State	:	MS
Zip	:	38851-0432
Country	:	US
Telephone Number	:	662-456-5008
Fax Number	:	662-456-5404

Provider Business Practice Location Address
First Line	:	1002 E MADISON ST STE 2
Second Line	:
City	:	HOUSTON
State	:	MS
Zip	:	38851-2428
Country	:	US
Telephone Number	:	662-456-5008
Fax Number	:	662-456-5404

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

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	01/18/2024

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

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