NPIMap

Organization Active NPI

Delta Physician Practices

  • Pediatrics Physician
  • Greenville, MS
National Provider Identifier
1235258252
Registry record updated Nov 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
DELTA PHYSICIAN PRACTICES
Practice address
526 Fairview Ave
Greenville, MS 38701-5401
Phone
(662) 332-0501
Fax
(662) 332-0176
NPI assigned
Mar 29, 2007
Organization subpart
Yes
Parent organization
DELTA PHYSICIAN PRACTICESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 14, 2022

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

Authorized official

Name
Iris Stacker
Title
Ceo
Phone
(662) 378-3783

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

526 Fairview Ave
Greenville, MS 38701-5401

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
09015100MedicaidMS
156272002MedicaidAR

National Provider Directory

National Provider Directory
Tax ID family
Delta Regional Medical15 organizations share this tax ID, including this one
Part of
Delta Regional Medical

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": "1175126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668384000000",
    "number": "1235258252",
    "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": "526 FAIRVIEW AVE",
            "city": "GREENVILLE",
            "state": "MS",
            "postal_code": "387015401",
            "telephone_number": "662-332-0501",
            "fax_number": "662-332-0176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DELTA PHYSICIAN PRACTICES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DELTA PHYSICIAN PRACTICES",
        "enumeration_date": "2007-03-29",
        "last_updated": "2022-11-14",
        "certification_date": "2022-11-14",
        "status": "A",
        "authorized_official_last_name": "STACKER",
        "authorized_official_first_name": "IRIS",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "662-378-3783"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09015100",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "156272002",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 14, 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.