Provider Demographics
NPI:1477651362
Name:DELTA HEALTH SYSTEM
Entity Type:Organization
Organization Name:DELTA HEALTH SYSTEM
Other - Org Name:DELTA HEALTH-THE MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INTERIM CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:IRIS
Authorized Official - Middle Name:Y
Authorized Official - Last Name:STACKER
Authorized Official - Suffix:
Authorized Official - Credentials:RHIA
Authorized Official - Phone:662-725-2099
Mailing Address - Street 1:P.O. BOX 5247
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38704-5247
Mailing Address - Country:US
Mailing Address - Phone:662-725-1200
Mailing Address - Fax:662-725-2309
Practice Address - Street 1:1693 FAIRGROUNDS RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38703-7810
Practice Address - Country:US
Practice Address - Phone:662-725-1200
Practice Address - Fax:662-725-2309
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DELTA HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-21
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2681251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00070599Medicaid
MS00070599Medicaid