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NPI Code Detail

MEDICARE: DELTA HEALTH SYSTEM

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
1261QR1300XRural Health Clinic/Center

Other Identifiers

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

General Provider Information

NPI Number : 1366592610
Entity Type Code : Organization
Provider Name (Legal Business Name) : DELTA HEALTH SYSTEM
Provider Business Mailing Address
First Line : PO BOX 4739
Second Line :
City : GREENVILLE
State : MS
Zip : 38704-4739
Country : US
Telephone Number : 662-725-2423
Fax Number : 662-725-2707
Provider Business Practice Location Address
First Line : 300 S WASHINGTON AVE
Second Line :
City : GREENVILLE
State : MS
Zip : 38701-4719
Country : US
Telephone Number : 662-344-9100
Fax Number : 662-725-1154
Authorized Official
Title or Position : INTERIM CEO
Name : MS. IRIS Y. STACKER
Credential : RHIA
Telephone Number : 662-725-2099
Provider Enumeration Date : 01/11/2007
Last Update Date : 10/17/2022

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Directions to “DELTA HEALTH SYSTEM ” Practice Location

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