NPIMap

Organization Active NPI

Southern Health Corp. of Houston, Inc

  • Rural Health Clinic/Center
  • Houston, MS
National Provider Identifier
1083721732
Registry record updated Jan 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
12-296 Issued in MS
Legal business name
SOUTHERN HEALTH CORP. OF HOUSTON, INC
Practice address
1002 E Madison St Ste 2
Houston, MS 38851-2428
Phone
(662) 456-5008
Fax
(662) 456-5404
NPI assigned
Aug 25, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2024

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)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 12-296 MS Primary

Addresses

Primary practice location

1002 E Madison St Ste 2
Houston, MS 38851-2428

Mailing address

PO Box 432
Houston, MS 38851-0432
Phone (662) 456-5008

Other identifiers 3

IdentifierTypeStateIssuer
09014528MedicaidMS
C02044OtherMSMEDICARE PART B GROUP
253422OtherMSTRISPAN

Other names 1

  • Family Medical Clinic of Houston Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

Change-of-ownership history 1

DateEventCounterparty
Jan 22, 2024 Change of OwnershipThis provider was the seller Progressive Health Clinic of HoustonCCN 253422, MS, NPI 1902663388

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

Practitioners & affiliated clinicians

Practitioners 33

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 33

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156464000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705536000000",
    "number": "1083721732",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 432",
            "city": "HOUSTON",
            "state": "MS",
            "postal_code": "388510432",
            "telephone_number": "662-456-5008",
            "fax_number": "662-456-5404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1002 E MADISON ST STE 2",
            "city": "HOUSTON",
            "state": "MS",
            "postal_code": "388512428",
            "telephone_number": "662-456-5008",
            "fax_number": "662-456-5404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN HEALTH CORP. OF HOUSTON, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-25",
        "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": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "MS",
            "license": "12-296",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09014528",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PART B GROUP",
            "identifier": "C02044",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRISPAN",
            "identifier": "253422",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Medical Clinic of Houston",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Family Medical Clinic of Houston",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Houston, MS

Sources for this page

Verify at the official NPI Registry.