Healthcare Provider Details

I. General information

NPI: 1083764542
Provider Name (Legal Business Name): DELTA HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E UNION ST
GREENVILLE MS
38703-3246
US

IV. Provider business mailing address

PO BOX 5247
GREENVILLE MS
38704-5247
US

V. Phone/Fax

Practice location:
  • Phone: 662-378-3783
  • Fax: 662-725-2289
Mailing address:
  • Phone: 662-378-3783
  • Fax: 662-725-2289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QX0200X
TaxonomyOncology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. IRIS Y. STACKER
Title or Position: CEO
Credential: RHIA
Phone: 662-725-2099