Provider Demographics
NPI:1851919658
Name:DELTA MED SOUTH, INC.
Entity Type:Organization
Organization Name:DELTA MED SOUTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-809-5387
Mailing Address - Street 1:7 COURT SQ
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:MS
Mailing Address - Zip Code:38921
Mailing Address - Country:US
Mailing Address - Phone:662-783-5054
Mailing Address - Fax:662-783-5053
Practice Address - Street 1:7 COURT SQ
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:MS
Practice Address - Zip Code:38921
Practice Address - Country:US
Practice Address - Phone:662-783-5054
Practice Address - Fax:662-783-5053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies