Provider Demographics
NPI:1225022262
Name:DEPORRES DELTA MINISTRIES, INC.
Entity Type:Organization
Organization Name:DEPORRES DELTA MINISTRIES, INC.
Other - Org Name:DEPORRES HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:J
Authorized Official - Last Name:DUERR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-326-9232
Mailing Address - Street 1:PO BOX 347
Mailing Address - Street 2:
Mailing Address - City:MARKS
Mailing Address - State:MS
Mailing Address - Zip Code:38646-0347
Mailing Address - Country:US
Mailing Address - Phone:662-326-9232
Mailing Address - Fax:662-326-8851
Practice Address - Street 1:411 POPLAR ST
Practice Address - Street 2:
Practice Address - City:MARKS
Practice Address - State:MS
Practice Address - Zip Code:38646-1338
Practice Address - Country:US
Practice Address - Phone:662-326-9232
Practice Address - Fax:662-326-8851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-06
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS207R00000X251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09014066Medicaid
MS1225022262Medicare Oscar/Certification
MS09014066Medicaid