| Trace Family Health & Internal Medicine | |
|
1002 E Madison St Ste B Houston MS 38851-2428 | |
| (662) 456-2800 | |
| (662) 456-1715 |
| Full Name | Trace Family Health & Internal Medicine |
|---|---|
| Speciality | Clinic/Center |
| Location | 1002 E Madison St Ste B, Houston, Mississippi |
| Authorized Official Name and Position | Sheila Brockman (CEO) |
| Authorized Official Contact | 6624563700 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Trace Family Health & Internal Medicine Po Box 432 Houston MS 38851-0432 Ph: (662) 456-2800 | Trace Family Health & Internal Medicine 1002 E Madison St Ste B Houston MS 38851-2428 Ph: (662) 456-2800 |
| NPI Number | 1194833400 |
|---|---|
| Provider Enumeration Date | 08/27/2006 |
| Last Update Date | 01/18/2024 |
| Medicare PECOS PAC ID | 0042102352 |
|---|---|
| Medicare Enrollment ID | O20040622001412 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194833400 | NPI | - | NPPES |
| 258518 | Other | MS | TRISPAN |
| C02335 | Other | MS | MEDICARE PART B GROUP |
| 07978511 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
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