Healthcare Provider Details

I. General information

NPI: 1225022262
Provider Name (Legal Business Name): DEPORRES DELTA MINISTRIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 03/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 POPLAR ST
MARKS MS
38646-1338
US

IV. Provider business mailing address

PO BOX 347
MARKS MS
38646-0347
US

V. Phone/Fax

Practice location:
  • Phone: 662-326-9232
  • Fax: 662-326-8851
Mailing address:
  • Phone: 662-326-9232
  • Fax: 662-326-8851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number207R00000X
License Number StateMS

VIII. Authorized Official

Name: MS. LAURA J DUERR
Title or Position: BUSINESS MANAGER
Credential:
Phone: 662-326-9232