Provider Demographics
NPI:1396033379
Name:DELTA CLINICS, PLC
Entity Type:Organization
Organization Name:DELTA CLINICS, PLC
Other - Org Name:HEART & VASCULAR CENTER OF WEST TN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SIMON
Authorized Official - Middle Name:OLALEKAN
Authorized Official - Last Name:OKEWOLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-512-0104
Mailing Address - Street 1:9486 HIGHWAY 412 W
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38351-5713
Mailing Address - Country:US
Mailing Address - Phone:731-512-0104
Mailing Address - Fax:731-668-7388
Practice Address - Street 1:9486 HIGHWAY 412 W
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:TN
Practice Address - Zip Code:38351-5713
Practice Address - Country:US
Practice Address - Phone:731-968-0984
Practice Address - Fax:731-668-7388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-12
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty