Active NPI
Southern Health Corp. of Houston, Inc.
Doing business as Trace Regional Hospital
- Clinic/Center
- Houston, MS
National Provider Identifier
1003096488
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinic/Center
- License
- 12-296
- Legal business name
- SOUTHERN HEALTH CORP. OF HOUSTON, INC.
- Doing business as
- Trace Regional Hospital
- Practice address
- 1002 E Madison St
Houston, MS 38851-2417 - Phone
- (662) 456-1163
- Fax
- (662) 456-1159
- NPI assigned
- Nov 14, 2007
- Last updated
- Jan 18, 2024
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Ms. Sheila Brockman
- Title
- Ceo
- Phone
- (662) 456-3700
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | 12-296 | MS | Primary |
Addresses
Primary practice location
1002 E Madison St
Houston, MS 38851-2417
Mailing address
PO Box 626
Houston, MS 38851-0626
Phone (662) 456-1163
Other names 1
- Trace Regional Hospital
National Provider Directory
National Provider Directory- Tax ID family
- Trace Regional Surgery
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Health Service Clinic/Center
- Okolona, MS
- NPI 1336220029
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1194998400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1705536000000",
"number": "1003096488",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 626",
"city": "HOUSTON",
"state": "MS",
"postal_code": "388510626",
"telephone_number": "662-456-1163",
"fax_number": "662-456-1159"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1002 E MADISON ST",
"city": "HOUSTON",
"state": "MS",
"postal_code": "388512417",
"telephone_number": "662-456-1163",
"fax_number": "662-456-1159"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SOUTHERN HEALTH CORP. OF HOUSTON, INC.",
"organizational_subpart": "NO",
"enumeration_date": "2007-11-14",
"last_updated": "2024-01-18",
"certification_date": "2024-01-18",
"status": "A",
"authorized_official_last_name": "BROCKMAN",
"authorized_official_first_name": "SHEILA",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "662-456-3700",
"authorized_official_name_prefix": "Ms."
},
"taxonomies": [
{
"code": "261Q00000X",
"taxonomy_group": "",
"desc": "Clinic/Center",
"state": "MS",
"license": "12-296",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Trace Regional Hospital",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Trace Regional Hospital",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Houston, MS
- Southern Health Corp of Houston Inc (Trace Regional Hospital)
- Southern Health Corp of Houston Inc (Floy Dyer Manor)
- Southern Health Corp of Houston, Inc. (Trace Regional Hospital)
- Southern Health Corp. of Houston, Inc (Family Medical Clinic of Houston)
- Southern Health Corp. of Houston, Inc (Trace Regional Hospital)
- Southern Health Corp. of Houston, Inc. (Trace Family Health & Internal Medicine)
- Southern Mobility Specialists Inc (Southern Mobility Specialists)
- Mary Alexandra Springer, NP
- Gladys Carla Staten
- Tamica N Stephens, PHARMD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.