MEDICARE: DELTA MEDICAL GROUP INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073149373
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DELTA MEDICAL GROUP INC

Provider Business Mailing Address
First Line	:	PO BOX 19238
Second Line	:
City	:	JONESBORO
State	:	AR
Zip	:	72403-6603
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	375 E MILLSAP RD STE 1
Second Line	:
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72703-6289
Country	:	US
Telephone Number	:	479-935-4949
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	KURT FOLDEN
Credential	:
Telephone Number	:	870-333-1230

Provider Enumeration Date	:	03/18/2020
Last Update Date	:	03/10/2023

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Directions to “DELTA MEDICAL GROUP INC ” Practice Location

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