Healthcare Provider Details

I. General information

NPI: 1245968718
Provider Name (Legal Business Name): DELTA CLINICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2022
Last Update Date: 08/29/2022
Certification Date: 08/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 PINECREST ST., STE 9
BRINKLEY AR
72021
US

IV. Provider business mailing address

1415 PINECREST ST., STE 9
BRINKLEY AR
72021
US

V. Phone/Fax

Practice location:
  • Phone: 870-300-3366
  • Fax: 870-300-3377
Mailing address:
  • Phone: 870-300-3366
  • Fax: 870-300-3377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARCO R MIDDLETON
Title or Position: OWNER
Credential: PHARMD
Phone: 870-830-7768