Provider Demographics
NPI:1174789549
Name:MISSOURI DELTA MEDICAL CENTER
Entity type:Organization
Organization Name:MISSOURI DELTA MEDICAL CENTER
Other - Org Name:
Other - Org Type:
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 N MAIN ST
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:573-471-1600
Mailing Address - Fax:
Practice Address - Street 1:123 SMITH AVE
Practice Address - Street 2:
Practice Address - City:SIKESTON
Practice Address - State:MO
Practice Address - Zip Code:63801-5239
Practice Address - Country:US
Practice Address - Phone:573-471-0200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MISSOURI DELTA MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-05
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
268635Medicare Oscar/Certification