Provider Demographics
NPI:1013236421
Name:MISSOURI DELTA MEDICAL CENTER
Entity Type:Organization
Organization Name:MISSOURI DELTA MEDICAL CENTER
Other - Org Name:WOMEN'S CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHRUMPF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-472-7601
Mailing Address - Street 1:1008 NORTH MAIN
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:573-472-7535
Mailing Address - Fax:573-472-7787
Practice Address - Street 1:1013 NORTH MAIN
Practice Address - Street 2:
Practice Address - City:SIKESTON
Practice Address - State:MO
Practice Address - Zip Code:63801
Practice Address - Country:US
Practice Address - Phone:573-472-7535
Practice Address - Fax:573-472-7787
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MISSOURI DELTA MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-05-25
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
268652Medicare Oscar/Certification