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General NPI Number Information
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NPI Number | 1609230507
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Entity Type | Organization
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Legal Business Name | MISSOURI DELTA MEDICAL CENTER
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Dates
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Enumeration Date | 04/07/2016
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Last Update Date | 04/07/2016
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Provider Practice Location Address
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Address Line | 6468 STATE HIGHWAY 77
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City | BENTON
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State | MO
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Zip | 63736-8237
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Country | US
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Telephone | 573-545-3700
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Fax |
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Provider Business Mailing Address
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Address Line | 1008 N MAIN ST
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City | SIKESTON
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State | MO
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Zip | 63801-5044
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Country | US
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Telephone | 573-545-3700
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JASON SCHRUMPF
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Credential |
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Telephone | 573-472-7601
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty 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 | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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