Provider Demographics
NPI:1508641838
Name:MISSOURI DELTA MEDICAL CENTER
Entity Type:Organization
Organization Name:MISSOURI DELTA MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING CONTACT
Authorized Official - Prefix:
Authorized Official - First Name:SANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZUCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-472-7423
Mailing Address - Street 1:1008 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SIKESTON
Mailing Address - State:MO
Mailing Address - Zip Code:63801-5044
Mailing Address - Country:US
Mailing Address - Phone:573-472-7423
Mailing Address - Fax:573-472-7475
Practice Address - Street 1:6468 STATE HIGHWAY 77
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:MO
Practice Address - Zip Code:63736-8237
Practice Address - Country:US
Practice Address - Phone:573-545-5155
Practice Address - Fax:573-545-5156
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MISSOURI DELTA MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-25
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy