Deporres Delta Ministries, Inc.

Primary specialty

Voluntary or Charitable AgencyTaxonomy code 251V00000X

License

207R00000X Issued in MS

Legal business name

DEPORRES DELTA MINISTRIES, INC.

Doing business as

DePorres Health Center

Practice address

411 Poplar St
Marks, MS 38646-1338

Phone

(662) 326-9232

Fax

(662) 326-8851

NPI assigned

Sep 6, 2005

Last updated

Mar 18, 2008By 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. Laura J Duerr

Title

Business Manager

Phone

(662) 326-9232

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• DePorres Health Center Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Andrea J Balconis, MD

  • Infectious Disease Physician
  • Fort Pierce, FL
  • NPI 1942213186
  NPD (past)

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

{
    "created_epoch": "1125964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205798400000",
    "number": "1225022262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 347",
            "city": "MARKS",
            "state": "MS",
            "postal_code": "386460347",
            "telephone_number": "662-326-9232",
            "fax_number": "662-326-8851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 POPLAR ST",
            "city": "MARKS",
            "state": "MS",
            "postal_code": "386461338",
            "telephone_number": "662-326-9232",
            "fax_number": "662-326-8851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEPORRES DELTA MINISTRIES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-06",
        "last_updated": "2008-03-18",
        "status": "A",
        "authorized_official_last_name": "DUERR",
        "authorized_official_first_name": "LAURA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "662-326-9232",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "251V00000X",
            "taxonomy_group": "",
            "desc": "Voluntary or Charitable",
            "state": "MS",
            "license": "207R00000X",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09014066",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DePorres Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• George Edward Farrell, FNP
• Courtney Fortner, FNP
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• Voluntary or Charitable Agency in Marks, MS
• Providers in Marks, MS by specialty
• Voluntary or Charitable Agency in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2008; 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.