MEDICARE: DELTA PHYSICIAN PRACTICES

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	207T00000X	Neurological Surgery Physician

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144349168
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DELTA PHYSICIAN PRACTICES

Provider Business Mailing Address
First Line	:	PO BOX 23998
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39225-3998
Country	:	US
Telephone Number	:	662-725-2749
Fax Number	:	662-725-2741

Provider Business Practice Location Address
First Line	:	1703 HOSPITAL ST
Second Line	:
City	:	GREENVILLE
State	:	MS
Zip	:	38703-3225
Country	:	US
Telephone Number	:	662-332-7720
Fax Number	:	662-332-7730

Authorized Official
Title or Position	:	CEO
Name	:	IRIS STACKER
Credential	:
Telephone Number	:	662-378-3783

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	11/14/2022

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Directions to “DELTA PHYSICIAN PRACTICES ” Practice Location

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