Provider Demographics
NPI:1679285332
Name:DELTA MEDICAL GROUP INC
Entity Type:Organization
Organization Name:DELTA MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KURT
Authorized Official - Middle Name:
Authorized Official - Last Name:FOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-333-1230
Mailing Address - Street 1:PO BOX 19238
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72403-6603
Mailing Address - Country:US
Mailing Address - Phone:870-333-1230
Mailing Address - Fax:
Practice Address - Street 1:1923 S NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2219
Practice Address - Country:US
Practice Address - Phone:870-333-1230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-14
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO620117769Medicaid