Delta Cardiovascular Center, PC

Primary specialty

SpecialistTaxonomy code 174400000X

License

16396 Issued in MS

Legal business name

DELTA CARDIOVASCULAR CENTER, PC

Practice address

520 Medical Dr
Clarksdale, MS 38614-6732

Phone

(662) 621-1915

Fax

(662) 621-9022

NPI assigned

Oct 17, 2006

Organization subpart

No

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

Authorized official

Name

Roger D Weiner, MD

Title

Ceo/President

Phone

(662) 621-1915

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 2

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

• Elizabeth Ewing Bailey, ACNP

  • Acute Care Nurse Practitioner
  • Tupelo, MS
  • NPI 1013941970
  NPD (past)
• Jules Pean, MD

  • Cardiovascular Disease Physician
  • Tucson, AZ
  • NPI 1164476602
  NPD (past)

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1401840000000",
    "number": "1386725513",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 MEDICAL DR",
            "city": "CLARKSDALE",
            "state": "MS",
            "postal_code": "386146732",
            "telephone_number": "662-621-1915",
            "fax_number": "662-621-9022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 MEDICAL DR",
            "city": "CLARKSDALE",
            "state": "MS",
            "postal_code": "386146732",
            "telephone_number": "662-621-1915",
            "fax_number": "662-621-9022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DELTA CARDIOVASCULAR CENTER, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-17",
        "last_updated": "2014-06-04",
        "status": "A",
        "authorized_official_last_name": "WEINER",
        "authorized_official_first_name": "ROGER",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CEO/PRESIDENT",
        "authorized_official_telephone_number": "662-621-1915",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "MS",
            "license": "16396",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "08952038",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "158639002",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jacory Curb Sr., QMHP-CS
• Kushna K Damallie, MD
• Faith Darby
• Otha Davis, MSW
• Tara Davis, F.N.P.
• Delta Compassionate Care Counseling
• Delta Concierge Medicine, Inc.
• Delta Discount Drugs Inc.
• Delta EMS
• Delta Health System

• Specialist in Clarksdale, MS
• Providers in Clarksdale, MS by specialty
• Specialist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2014; 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.