NPIMap

Organization Active NPI

Delta Health Center, Inc

Doing business as DHC-Moorhead Central School

  • Federally Qualified Health Center (FQHC)
  • Moorhead, MS
National Provider Identifier
1285280180
Registry record updated Jul 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
DELTA HEALTH CENTER, INC
Doing business as
DHC-Moorhead Central School
Practice address
506 Washington Avenue
Moorhead, MS 38761
Phone
(662) 246-5680
Fax
(662) 246-5080
NPI assigned
Aug 15, 2019
Last updated
Jul 8, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2025

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

Authorized official

Name
Myrtis Small
Title
HR-Credentialing Director
Phone
(662) 741-8889

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

506 Washington Avenue
Moorhead, MS 38761

Mailing address

702 Martin Luther King St
Mound Bayou, MS 38762-9314
Phone (662) 741-8800

Other identifiers 2

IdentifierTypeStateIssuer
09013118MedicaidMS
01635257MedicaidMS

Other names 1

  • DHC-MOORHEAD CENTRAL SCHOOL Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040216000676 MS Part B Supplier - Clinic/Group Practice 6608783295 Receives reassigned benefits from 27 practitioners
17 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Itta Bena, MS; Ruleville, MS; Rolling Fork, MS; Mound Bayou, MS; Moorhead, MS; Mayersville, MS; Leland, MS; Indianola, MS…
O20191014000868 MS Part A Provider - Federally Qualified Health Center (FQHC) 6608783295 Practice locations: Moorhead, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1285280180. Details of each certification follow.

Federally qualified health center certification: CCN 251096

Legal name
DELTA HEALTH CENTER, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 9, 2019
Last certification
Oct 9, 2019
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Feb 27, 1967 in MS
Enrollment address
506 Washington Avenue
Moorhead, MS 38761-6605

Other NPIs with the same Medicare PAC ID 17

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 17

Other NPIs on the same Medicare enrollment 17

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 17

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
25D2171531Delta Health Center Moorhead Central506 Washington Avenue, Moorhead, MS 38761Certificate of waiverSep 2, 2027

National Provider Directory

National Provider Directory
Tax ID family
Delta Health Center34 organizations share this tax ID, including this one

Other organizations with this tax ID 33

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

View all 33

Ownership & related parties

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
John a Fairman Individual Corporate OfficerCeo Aug 1, 2009 100%
W-2 Managing EmployeeCeo Aug 1, 2009 100%
Hazel D Whiting Individual W-2 Managing EmployeeChief Financial Officer Nov 5, 2009

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Delta Health Center, Inc.Rolling Fork, MS, CCN 251035 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Aug 1, 2009
Delta Health Center, Inc.Hollandale, MS, CCN 251033 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Aug 1, 2009
DHC-LelandLeland, MS, CCN 251113 Federally qualified health center Operational/Managerial Control (100%) Aug 1, 2009
DHC -MvsuItta Bena, MS, CCN 251117 Federally qualified health center Operational/Managerial Control (100%) Aug 1, 2009

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1565827200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1751932800000",
    "number": "1285280180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "702 MARTIN LUTHER KING ST",
            "city": "MOUND BAYOU",
            "state": "MS",
            "postal_code": "387629314",
            "telephone_number": "662-741-8800",
            "fax_number": "662-741-2700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "506 WASHINGTON AVENUE",
            "city": "MOORHEAD",
            "state": "MS",
            "postal_code": "38761",
            "telephone_number": "662-246-5680",
            "fax_number": "662-246-5080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DELTA HEALTH CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-15",
        "last_updated": "2025-07-08",
        "certification_date": "2025-07-08",
        "status": "A",
        "authorized_official_last_name": "SMALL",
        "authorized_official_first_name": "MYRTIS",
        "authorized_official_title_or_position": "HR-CREDENTIALING DIRECTOR",
        "authorized_official_telephone_number": "662-741-8889"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09013118",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01635257",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DHC-MOORHEAD CENTRAL SCHOOL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Moorhead, MS

Sources for this page

Verify at the official NPI Registry.