Provider Demographics
NPI:1376682872
Name:DELTA MANAGEMENT GROUP INC
Entity Type:Organization
Organization Name:DELTA MANAGEMENT GROUP INC
Other - Org Name:YUKON MEDICAL SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:OBEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-543-4207
Mailing Address - Street 1:PO BOX 2703
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:AK
Mailing Address - Zip Code:99559-2703
Mailing Address - Country:US
Mailing Address - Phone:907-543-4207
Mailing Address - Fax:
Practice Address - Street 1:1100 EDDIE HOFFMAN A. HWY.
Practice Address - Street 2:SUITE L.
Practice Address - City:BETHEL
Practice Address - State:AK
Practice Address - Zip Code:99559-2703
Practice Address - Country:US
Practice Address - Phone:907-543-4207
Practice Address - Fax:907-543-4207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMS9891Medicaid
4868290001Medicare ID - Type UnspecifiedCMS PROVIDER ID#