NPIMap

Delta Health Center, Inc.

Organization Active NPI Federally Qualified Health Center (FQHC) · Rolling Fork, MS

NPI 1336517606 · NPPES record last updated Jul 8, 2025

Key facts

NPI
1336517606
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name
DELTA HEALTH CENTER, INC.
Practice address
20400 Highway 61
Rolling Fork, MS 39159
Phone
(662) 741-2151
Fax
(662) 741-2700
NPI assigned
Sep 3, 2015
Organization subpart
No

Authorized official

Name
Mr. John A. Fairman
Title
Chief Executive Officer
Phone
(662) 741-8880

Owners & managing parties with NPI records 17

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Owned or controlled facilities with NPI records 3

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

Other NPIs on the same Medicare enrollment 17

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

Other NPIs with the same Medicare PAC ID 17

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

Corporate family (same tax ID) 33

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

View all 33

Facilities with the same owner 3

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in MS

Federally qualified health center certification: CCN 251035

Legal name
DELTA HEALTH CENTER, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 27, 2016
Last certification
Jan 27, 2016
Ownership / control type
For profit – corporation
Organization structure
Corporation · Non-profit
Incorporated
Feb 27, 1967 in MS
Enrollment address
20400 Highway 61
Rolling Fork, MS 39159

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Delta Health Center, Inc.
Organization · Rolling Fork, MS
Corporation, Non-profit 		5% Or Greater Direct Ownership Interest Aug 1, 2009 100%
John a Fairman
Individual 		Corporate Officer
Ceo		 Aug 1, 2009 100%
W-2 Managing Employee
Ceo		 Nov 1, 2015 100%
Hazel D Whiting
Individual 		W-2 Managing Employee
Chief Financial Officer		 Nov 1, 2015

All facility ownership & control disclosures 3

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

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

Medicare enrollment records

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…
O20160201002000 MS Part a Provider - Federally Qualified Health Center (FQHC) 6608783295 Practice locations: Rolling Fork, MS

National Provider Directory

Tax ID family
Women Pediatric Clinic (34 organizations share this tax ID)

Specialties & licenses

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

Addresses

Primary practice location

20400 Highway 61
Rolling Fork, MS 39159

Mailing address

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

Other providers in Rolling Fork, MS

All providers in Rolling Fork, MS · Federally Qualified Health Center (FQHC) in Mississippi

Sources for this page

Verify at the official NPI Registry.