NPIMap

Organization Active NPI

Delta Concierge Medicine, Inc.

  • Health Maintenance Organization
  • Clarksdale, MS
National Provider Identifier
1598049264
Registry record updated Sep 29, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Maintenance OrganizationTaxonomy code 302R00000X
License
16776 Issued in MS
Legal business name
DELTA CONCIERGE MEDICINE, INC.
Practice address
705 N State St
Clarksdale, MS 38614-6519
Phone
(662) 621-2192
NPI assigned
Sep 29, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2011

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

Authorized official

Name
Dr. Kenneth Kellough
Title
Chief Executive Officer
Phone
(662) 621-2192

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Maintenance Organization 302R00000X 16776 MS Primary

Addresses

Primary practice location

705 N State St
Clarksdale, MS 38614-6519

Mailing address

PO Box 1930
Clarksdale, MS 38614-7930

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1317254400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1317254400000",
    "number": "1598049264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1930",
            "city": "CLARKSDALE",
            "state": "MS",
            "postal_code": "386147930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 N STATE ST",
            "city": "CLARKSDALE",
            "state": "MS",
            "postal_code": "386146519",
            "telephone_number": "662-621-2192"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DELTA CONCIERGE MEDICINE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-29",
        "last_updated": "2011-09-29",
        "status": "A",
        "authorized_official_last_name": "KELLOUGH",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "662-621-2192",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": "MS",
            "license": "16776",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clarksdale, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2011; 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.