Provider Demographics
NPI:1366592610
Name:DELTA HEALTH SYSTEM
Entity type:Organization
Organization Name:DELTA HEALTH SYSTEM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INTERIM CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:IRIS
Authorized Official - Middle Name:Y
Authorized Official - Last Name:STACKER
Authorized Official - Suffix:
Authorized Official - Credentials:RHIA
Authorized Official - Phone:662-725-2099
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:662-725-2423
Mailing Address - Fax:662-725-2707
Practice Address - Street 1:300 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38701-4719
Practice Address - Country:US
Practice Address - Phone:662-344-9100
Practice Address - Fax:662-725-1154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09015375Medicaid
MS25-3461Medicare Oscar/Certification