Provider Demographics
NPI:1851956577
Name:DELTA MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:DELTA MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:J
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-382-8267
Mailing Address - Street 1:811 HIGHWAY 65 S
Mailing Address - Street 2:
Mailing Address - City:DUMAS
Mailing Address - State:AR
Mailing Address - Zip Code:71639-3006
Mailing Address - Country:US
Mailing Address - Phone:870-382-8145
Mailing Address - Fax:870-382-7645
Practice Address - Street 1:811 HIGHWAY 65 S
Practice Address - Street 2:
Practice Address - City:DUMAS
Practice Address - State:AR
Practice Address - Zip Code:71639-3006
Practice Address - Country:US
Practice Address - Phone:870-382-8145
Practice Address - Fax:870-382-7645
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DELTA MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-05-08
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty