Provider Demographics
NPI:1386011799
Name:DELTA HEALTHCARE CENTER, P.C.
Entity Type:Organization
Organization Name:DELTA HEALTHCARE CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MENE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZUA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-868-3131
Mailing Address - Street 1:1308 BRIARVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-5127
Mailing Address - Country:US
Mailing Address - Phone:615-868-3131
Mailing Address - Fax:615-515-0205
Practice Address - Street 1:1308 BRIARVILLE RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-5127
Practice Address - Country:US
Practice Address - Phone:615-868-3131
Practice Address - Fax:615-515-0205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-02
Last Update Date:2016-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ018394Medicaid
TNQ018394Medicaid