NPIMap

Organization Active NPI

Delta Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Greenville, MS
National Provider Identifier
1508057076
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.
Practice address
1414 Hospital St
Greenville, MS 38703-3217
Phone
(662) 335-3991
Fax
(662) 332-1736
NPI assigned
Aug 8, 2007
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
Mr. John Fairman
Title
Ceo
Phone
(662) 741-2358

Specialties & licenses 1

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

Addresses

Primary practice location

1414 Hospital St
Greenville, MS 38703-3217

Mailing address

702 Martin Luther King Road
Post Office Box 900
Mound Bayou, MS 38762-0900
Phone (662) 335-3991

Other identifiers 1

IdentifierTypeStateIssuer
09014251MedicaidMS

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20030129000019 MS Part A Provider - Federally Qualified Health Center (FQHC) 6608783295 Practice locations: Greenville, MS
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…

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1508057076. Details of each certification follow.

Federally qualified health center certification: CCN 251902

Legal name
DELTA HEALTH CENTER, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 22, 2002
Last certification
Oct 22, 2002
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 27, 1972 in MS
Enrollment address
1414 Hospital Street
Greenville, MS 38703-3217

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
25D0866231Delta Health Center Satellite Lab1414 Hospital Street, Greenville, MS 38703Certificate of waiverJun 5, 2028

National Provider Directory

National Provider Directory
Tax ID family
Delta Health Clinic Inc34 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

Locations

1414 Hospital St
Greenville, MS 38703
Phone (662) 335-3991

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Mitchell Williams Individual Corporate Director Jan 1, 2008
Jack King Individual Corporate Director Jan 2, 1996
Carmere Scott Individual Corporate Director Jan 29, 2003
Shannon Brown Individual Corporate Director Jan 1, 2008
Dorothy Walls Individual Corporate Director Jan 1, 2008
John a Fairman Individual Corporate Director Aug 3, 2009
W-2 Managing Employee Aug 3, 2009
James Hodges Individual Corporate Director Jan 1, 2005
Shawneequa Beal Individual Corporate Director Jan 1, 2009
Hazel D Whiting Individual Corporate Director 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 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": "1186531200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1751932800000",
    "number": "1508057076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "702 MARTIN LUTHER KING ROAD",
            "address_2": "POST OFFICE BOX 900",
            "city": "MOUND BAYOU",
            "state": "MS",
            "postal_code": "387620900",
            "telephone_number": "662-335-3991",
            "fax_number": "662-332-1736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1414 HOSPITAL ST",
            "city": "GREENVILLE",
            "state": "MS",
            "postal_code": "387033217",
            "telephone_number": "662-335-3991",
            "fax_number": "662-332-1736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DELTA HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-08",
        "last_updated": "2025-07-08",
        "certification_date": "2025-07-08",
        "status": "A",
        "authorized_official_last_name": "FAIRMAN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "662-741-2358",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09014251",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, MS

Sources for this page

Verify at the official NPI Registry.