MEDICARE: DELTA HEALTH SYSTEM

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	261QX0200X	Oncology Clinic/Center

General Provider Information

NPI Number	:	1184232498
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DELTA HEALTH SYSTEM

Provider Business Mailing Address
First Line	:	PO BOX 5247
Second Line	:
City	:	GREENVILLE
State	:	MS
Zip	:	38704-5247
Country	:	US
Telephone Number	:	662-334-2021
Fax Number	:	662-725-2189

Provider Business Practice Location Address
First Line	:	1514 E UNION ST
Second Line	:
City	:	GREENVILLE
State	:	MS
Zip	:	38703-3248
Country	:	US
Telephone Number	:	662-334-6394
Fax Number	:	662-332-1647

Authorized Official
Title or Position	:	CEO
Name	:	MS. IRIS Y. STACKER
Credential	:	RHIA
Telephone Number	:	662-725-2099

Provider Enumeration Date	:	07/22/2020
Last Update Date	:	10/17/2022

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Directions to “DELTA HEALTH SYSTEM ” Practice Location

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