Healthcare Provider Details

I. General information

NPI: 1447368600
Provider Name (Legal Business Name): MID-DELTA HEALTH SYSTEMS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 07/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 N HAYDEN ST
BELZONI MS
39038-3639
US

IV. Provider business mailing address

PO BOX 373 405 NORTH HAYDEN STREET
BELZONI MS
39038-0373
US

V. Phone/Fax

Practice location:
  • Phone: 662-247-1254
  • Fax: 662-247-4924
Mailing address:
  • Phone: 662-247-1254
  • Fax: 662-247-4924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. CLARA TAYLOR REED
Title or Position: CEO
Credential: RN
Phone: 662-247-1254