Healthcare Provider Details

I. General information

NPI: 1285280180
Provider Name (Legal Business Name): DELTA HEALTH CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2019
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 WASHINGTON AVENUE
MOORHEAD MS
38761
US

IV. Provider business mailing address

702 MARTIN LUTHER KING ST
MOUND BAYOU MS
38762-9314
US

V. Phone/Fax

Practice location:
  • Phone: 662-246-5680
  • Fax: 662-246-5080
Mailing address:
  • Phone: 662-741-8800
  • Fax: 662-741-2700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MYRTIS SMALL
Title or Position: HR-CREDENTIALING DIRECTOR
Credential:
Phone: 662-741-8889