Provider Demographics
NPI:1619923661
Name:DELTA ENDOSCOPY CENTER, P.C.
Entity Type:Organization
Organization Name:DELTA ENDOSCOPY CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GASTROENTEROLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ULRIC
Authorized Official - Middle Name:D
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-280-8222
Mailing Address - Street 1:9140 HIGHWAY 51 N
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-1233
Mailing Address - Country:US
Mailing Address - Phone:662-280-8222
Mailing Address - Fax:662-280-5541
Practice Address - Street 1:9140 HIGHWAY 51 N
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-1233
Practice Address - Country:US
Practice Address - Phone:662-280-8222
Practice Address - Fax:662-280-5541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS15684261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00770356Medicaid
MS3134453OtherBLUECROSS BLUESHIELD TN
MS4287022OtherTENNESEE MEDICAID
MS=========OtherMUTUAL OF OMAHA
TN=========OtherTLC
=========OtherAETNA
MS=========OtherBLUECROSS BLUESHIELD
=========OtherCIGNA
=========OtherTCS
MS4287022OtherTENNESEE MEDICAID
=========OtherUNITED HEALTHCARE