Healthcare Provider Details

I. General information

NPI: 1831830637
Provider Name (Legal Business Name): DELTA MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 12/14/2022
Certification Date: 12/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 MCLAIN ST
NEWPORT AR
72112-3634
US

IV. Provider business mailing address

PO BOX 19238
JONESBORO AR
72403-6603
US

V. Phone/Fax

Practice location:
  • Phone: 870-495-1013
  • Fax: 870-495-1014
Mailing address:
  • Phone: 870-333-1230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: KURT FOLDEN
Title or Position: CEO
Credential:
Phone: 870-333-1230