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General NPI Number Information
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NPI Number | 1174506281
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Entity Type | Organization
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Legal Business Name | DELTA HEART & VASCULAR CENTER, P.A.
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Dates
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Enumeration Date | 11/22/2005
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Last Update Date | 05/20/2021
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Provider Practice Location Address
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Address Line | 1421 E UNION ST
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City | GREENVILLE
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State | MS
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Zip | 38703-3247
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Country | US
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Telephone | 662-335-0183
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Fax | 662-335-7184
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Provider Business Mailing Address
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Address Line | 1421 E UNION ST
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City | GREENVILLE
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State | MS
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Zip | 38703-3247
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Country | US
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Telephone | 662-335-0183
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Fax | 662-335-7184
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Authorized Official
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Title or Position | CEO/MD
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Name | JOHN L HERZOG
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Credential |
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Telephone | 662-335-0183
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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