Provider Demographics
NPI:1841841210
Name:DELTA REGIONAL MEDICAL CENTER
Entity type:Organization
Organization Name:DELTA REGIONAL MEDICAL CENTER
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:662-725-2264
Mailing Address - Street 1:PO BOX 4739
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38704-4739
Mailing Address - Country:US
Mailing Address - Phone:662-378-3783
Mailing Address - Fax:
Practice Address - Street 1:108 MAIN STREET
Practice Address - Street 2:
Practice Address - City:ARCOLA
Practice Address - State:MS
Practice Address - Zip Code:38722
Practice Address - Country:US
Practice Address - Phone:662-378-3783
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DELTA REGIONAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-09-26
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty