NPIMap

Organization Active NPI

Delta Health Center, Inc

Doing business as DHC - Rosedale

  • Federally Qualified Health Center (FQHC)
  • Rosedale, MS
National Provider Identifier
1306705892
Registry record updated Jan 20, 2026
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 - Rosedale
Practice address
1302 Main St
Rosedale, MS 38769
Phone
(662) 741-8800
NPI assigned
Jan 20, 2026
Last updated
Jan 20, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2026

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

Authorized official

Name
Myrtis Small
Title
Director of Human Resources
Phone
(662) 741-8889

Specialties & licenses 1

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

Addresses

Primary practice location

1302 Main St
Rosedale, MS 38769

Mailing address

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

Other names 1

  • DHC - Rosedale Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20260506000221 MS Part A Provider - Federally Qualified Health Center (FQHC) 6608783295 Practice locations: Rosedale, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1306705892. Details of each certification follow.

Federally qualified health center certification: CCN 251184

Legal name
DELTA HEALTH CENTER, INC.
Doing business as
DHC-ROSEDALE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 10, 2026
Last certification
Mar 10, 2026
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
1302 Main St
Rosedale, MS 38769

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

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
25D2104731Delta Health Center-Rosedale1302 South Main Street, Rosedale, MS 38769Certificate of waiverNov 9, 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 1

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%

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 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.

NPI Registry JSON

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

{
    "created_epoch": "1768867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1768867200000",
    "number": "1306705892",
    "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": "662-741-2268"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1302 MAIN ST",
            "city": "ROSEDALE",
            "state": "MS",
            "postal_code": "38769",
            "telephone_number": "662-741-8800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DELTA HEALTH CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-01-20",
        "last_updated": "2026-01-20",
        "certification_date": "2026-01-20",
        "status": "A",
        "authorized_official_last_name": "SMALL",
        "authorized_official_first_name": "MYRTIS",
        "authorized_official_title_or_position": "DIRECTOR OF HUMAN RESOURCES",
        "authorized_official_telephone_number": "662-741-8889"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DHC - Rosedale",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rosedale, MS

Sources for this page

Verify at the official NPI Registry.