Delta Wellness Clinic for Families LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

14161 Issued in MS

Legal business name

DELTA WELLNESS CLINIC FOR FAMILIES LLC

Practice address

1585 S Main St
Greenville, MS 38701-7008

Phone

(662) 332-8848

Fax

(662) 332-8854

NPI assigned

Jun 20, 2013

Last updated

Jun 20, 2013By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Katherine Colbert, CPC

Title

Business Manager

Phone

(662) 332-8848

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1371686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1371686400000",
    "number": "1144669375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4577",
            "city": "GREENVILLE",
            "state": "MS",
            "postal_code": "387044577",
            "telephone_number": "662-332-8848",
            "fax_number": "662-332-8854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1585 S MAIN ST",
            "city": "GREENVILLE",
            "state": "MS",
            "postal_code": "387017008",
            "telephone_number": "662-332-8848",
            "fax_number": "662-332-8854"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DELTA WELLNESS CLINIC FOR FAMILIES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-20",
        "last_updated": "2013-06-20",
        "status": "A",
        "authorized_official_last_name": "COLBERT",
        "authorized_official_first_name": "KATHERINE",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "662-332-8848",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "CPC"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "MS",
            "license": "14161",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00114839",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Dental Group of Greenville
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• Diabetic and Medial Supply
• Gregg Alan Dickerson, M.D.
• Direct Transportation System, LLC

• Primary Care Clinic/Center in Greenville, MS
• Providers in Greenville, MS by specialty
• Primary Care Clinic/Center in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.