1215583356 NPI number — DELTA HEALTH CENTER, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215583356 NPI number — DELTA HEALTH CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DELTA HEALTH CENTER, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215583356
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/08/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 900
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUND BAYOU
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38762-0900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-884-1260
Provider Business Mailing Address Fax Number:
662-741-2700

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
302 COLLEGE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDIANOLA
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38751-2112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-884-1260
Provider Business Practice Location Address Fax Number:
662-741-2700
Provider Enumeration Date:
08/14/2019

Additional Information

Authorized Official

Authorized Official Last Name:
SMALL
Authorized Official First Name:
MYRTIS
Authorized Official Middle Name:
Authorized Official Title or Position:
HR/CREDENTIALING
Authorized Official Telephone Number:
662-741-8889

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 09013118 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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