Healthcare Provider Details

I. General information

NPI: 1962778985
Provider Name (Legal Business Name): DELTA MEDICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2012
Last Update Date: 04/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 GETWELL RD
MEMPHIS TN
38118-2205
US

IV. Provider business mailing address

3000 GETWELL ROAD
MEMPHIS TN
38118
US

V. Phone/Fax

Practice location:
  • Phone: 901-369-6089
  • Fax: 901-369-6925
Mailing address:
  • Phone: 901-369-8517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. CHRISTOPHER HOWARD
Title or Position: VP & SECRETARY
Credential:
Phone: 615-861-6000