NPIMap

Organization Active NPI

Delta Physician Practices

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Greenville, MS
National Provider Identifier
1467571430
Registry record updated Nov 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X
Legal business name
DELTA PHYSICIAN PRACTICES
Practice address
1202 Hospital St
Greenville, MS 38703-3213
Phone
(662) 335-6703
Fax
(662) 335-6705
NPI assigned
Mar 28, 2007
Last updated
Nov 14, 2022By the provider in NPPES
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
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X NU Primary

Addresses

Primary practice location

1202 Hospital St
Greenville, MS 38703-3213

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 Physician Practices15 organizations share this tax ID, including this one
Part of
Delta Physician Practices

Other organizations with this tax ID 14

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

View all 14

Locations

1202 Hospital St
Greenville, MS 38703
Phone (662) 334-8564

Practitioners & affiliated clinicians

Practitioners 3

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": "1175040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668384000000",
    "number": "1467571430",
    "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": "1202 HOSPITAL ST",
            "city": "GREENVILLE",
            "state": "MS",
            "postal_code": "387033213",
            "telephone_number": "662-335-6703",
            "fax_number": "662-335-6705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DELTA PHYSICIAN PRACTICES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DELTA PHYSICIAN PRACTICES",
        "enumeration_date": "2007-03-28",
        "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": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "NU",
            "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.