Healthcare Provider Details

I. General information

NPI: 1427572007
Provider Name (Legal Business Name): MISSOURI DELTA MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2017
Last Update Date: 07/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 W YOAKUM AVE
CHAFFEE MO
63740-1138
US

IV. Provider business mailing address

1008 N MAIN ST
SIKESTON MO
63801-5044
US

V. Phone/Fax

Practice location:
  • Phone: 573-887-4171
  • Fax:
Mailing address:
  • Phone: 573-472-7406
  • Fax: 573-472-7475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JASON SCHRUMPF
Title or Position: CEO
Credential:
Phone: 573-472-7601