Provider Demographics
NPI:1497830806
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 1:1400 E UNION ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38703-3246
Mailing Address - Country:US
Mailing Address - Phone:662-378-3783
Mailing Address - Fax:662-725-2289
Practice Address - Street 1:300 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38701-4719
Practice Address - Country:US
Practice Address - Phone:662-378-3783
Practice Address - Fax:662-725-2289
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DELTA HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-25
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS11-189273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS25S082Medicare Oscar/Certification