Healthcare Provider Details

I. General information

NPI: 1225948474
Provider Name (Legal Business Name): MISSOURI DELTA MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 S HICKMAN ST
PUXICO MO
63960-9122
US

IV. Provider business mailing address

250 S HICKMAN ST
PUXICO MO
63960-9122
US

V. Phone/Fax

Practice location:
  • Phone: 573-222-2292
  • Fax: 573-222-2383
Mailing address:
  • Phone: 573-222-2292
  • Fax: 573-222-2383

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: LATINA HAMPTON
Title or Position: DIRECTOR
Credential:
Phone: 573-472-7333