MEDICARE: DELTA MEDICAL SERVICES

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	251T00000X	PACE Provider Organization	11385	LA

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	:	1275703225
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DELTA MEDICAL SERVICES

Provider Business Mailing Address
First Line	:	1800 BUCKNER ST STE B210
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71101-4438
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1800 BUCKNER ST STE B210
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71101-4438
Country	:	US
Telephone Number	:	318-459-1600
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	DORIS MITCHELL
Credential	:
Telephone Number	:	318-459-1600

Provider Enumeration Date	:	03/06/2008
Last Update Date	:	03/06/2008

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Directions to “DELTA MEDICAL SERVICES ” Practice Location

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