Provider Demographics
NPI:1831863950
Name:DELTA HEALTH SYSTEM
Entity type:Organization
Organization Name:DELTA HEALTH SYSTEM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:IRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:STACKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-725-2020
Mailing Address - Street 1:PO BOX 4597
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38704-4597
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:785 OHIO AVE STE 1H
Practice Address - Street 2:
Practice Address - City:CLARKSDALE
Practice Address - State:MS
Practice Address - Zip Code:38614-6213
Practice Address - Country:US
Practice Address - Phone:662-624-8400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DELTA HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-08-03
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health