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General NPI Number Information
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NPI Number | 1245968718
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Entity Type | Organization
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Legal Business Name | DELTA CLINICAL SERVICES LLC
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Dates
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Enumeration Date | 08/11/2022
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Last Update Date | 08/29/2022
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Provider Practice Location Address
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Address Line | 1415 PINECREST ST., STE 9
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City | BRINKLEY
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State | AR
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Zip | 72021
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Country | US
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Telephone | 870-300-3366
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Fax | 870-300-3377
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Provider Business Mailing Address
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Address Line | 1415 PINECREST ST., STE 9
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City | BRINKLEY
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State | AR
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Zip | 72021
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Country | US
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Telephone | 870-300-3366
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Fax | 870-300-3377
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Authorized Official
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Title or Position | OWNER
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Name | MARCO R MIDDLETON
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Credential | PHARMD
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Telephone | 870-830-7768
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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