SOUTHERN HEALTH CORP. OF HOUSTON INC. NPI 1194833400

NPI Information

NPI: 1194833400
Provider Name: SOUTHERN HEALTH CORP. OF HOUSTON, INC.

Doing Business As: TRACE FAMILY HEALTH & INTERNAL MEDICINE

Classification: Clinic/Center - 261QR1300X
Entity Type: Organization

Specialization: Rural Health

Address:
1002 E MADISON ST STE B
HOUSTON, MS
ZIP 38851
Phone: (662) 456-2800
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SOUTHERN HEALTH CORP. OF HOUSTON, INC. is a rural health clinic center in Houston, MS. SOUTHERN HEALTH CORP. OF HOUSTON, INC. NPI is 1194833400. The provider is registered as an organization entity type.
The provider Is Doing Business As Trace Family Health & Internal Medicine.

The provider's business location address is:

1002 E MADISON ST STE B
HOUSTON, MS
ZIP 38851-428
Phone: (662) 456-2800
Fax: (662) 456-1715

The provider's authorized official is Sheila Brockman .
The authorized official title is Ceo and has the following contact phone number (662) 456-3700.

The CLIA number assigned to this NPI record is 25D1016606 - rural health clinic with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 8/27/2006 and was last updated on 1/18/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QR1300X	Clinic/Center	Rural Health			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	258518	OTHER	MISSISSIPPI	TRISPAN
2	C02335	OTHER	MISSISSIPPI	MEDICARE PART B GROUP
3	07978511	MEDICAID	MISSISSIPPI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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