MEDICARE: DELTA REGIONAL MEDICAL CENTER

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1841841210
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DELTA REGIONAL MEDICAL CENTER

Provider Business Mailing Address
First Line	:	PO BOX 4739
Second Line	:
City	:	GREENVILLE
State	:	MS
Zip	:	38704-4739
Country	:	US
Telephone Number	:	662-378-3783
Fax Number	:

Provider Business Practice Location Address
First Line	:	108 MAIN STREET
Second Line	:
City	:	ARCOLA
State	:	MS
Zip	:	38722
Country	:	US
Telephone Number	:	662-378-3783
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	IRIS STACKER
Credential	:
Telephone Number	:	662-725-2264

Provider Enumeration Date	:	09/26/2019
Last Update Date	:	11/14/2022

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Directions to “DELTA REGIONAL MEDICAL CENTER ” Practice Location

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