Healthcare Provider Details

I. General information

NPI: 1619923661
Provider Name (Legal Business Name): DELTA ENDOSCOPY CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9140 HIGHWAY 51 N
SOUTHAVEN MS
38671-1233
US

IV. Provider business mailing address

9140 HIGHWAY 51 N
SOUTHAVEN MS
38671-1233
US

V. Phone/Fax

Practice location:
  • Phone: 662-280-8222
  • Fax: 662-280-5541
Mailing address:
  • Phone: 662-280-8222
  • Fax: 662-280-5541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number15684
License Number StateMS

VIII. Authorized Official

Name: DR. ULRIC D. DUNCAN
Title or Position: GASTROENTEROLOGIST
Credential: M.D.
Phone: 662-280-8222