NPIMap

Organization Active NPI

Delta Physician Practices

  • Gastroenterology Physician
  • Greenville, MS
National Provider Identifier
1174642144
Registry record updated Nov 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
Legal business name
DELTA PHYSICIAN PRACTICES
Practice address
1502 S Colorado St
Greenville, MS 38703-7219
Phone
(662) 332-9872
NPI assigned
Mar 28, 2007
Last updated
Nov 4, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
DELTA PHYSICIAN PRACTICESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 4, 2022

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

Authorized official

Name
Ms. Iris Stacker
Title
Ceo
Phone
(662) 725-2264

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X NU
Gastroenterology Physician 207RG0100X NU Primary

Addresses

Primary practice location

1502 S Colorado St
Greenville, MS 38703-7219

Mailing address

PO Box 23998
Jackson, MS 39225-3998
Phone (662) 725-2749

Other identifiers 2

IdentifierTypeStateIssuer
156272002MedicaidAR
09015100MedicaidMS

Other names 1

  • Delta Health-Greenville Medical Group Other name

National Provider Directory

National Provider Directory
Tax ID family
Delta Physician Practices15 organizations share this tax ID, including this one
Part of
Delta Physician Practices

Other organizations with this tax ID 14

Organizations that report the same tax identification number in the National Provider Directory.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1175040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667520000000",
    "number": "1174642144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23998",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392253998",
            "telephone_number": "662-725-2749",
            "fax_number": "662-725-2741"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1502 S COLORADO ST",
            "city": "GREENVILLE",
            "state": "MS",
            "postal_code": "387037219",
            "telephone_number": "662-332-9872"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DELTA PHYSICIAN PRACTICES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DELTA PHYSICIAN PRACTICES",
        "enumeration_date": "2007-03-28",
        "last_updated": "2022-11-04",
        "certification_date": "2022-11-04",
        "status": "A",
        "authorized_official_last_name": "STACKER",
        "authorized_official_first_name": "IRIS",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "662-725-2264",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "156272002",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09015100",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Delta Health-Greenville Medical Group",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Greenville, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2022; 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.