NPIMap

Organization Active NPI

Delta Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Indianola, MS
National Provider Identifier
1629495452
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
118 Front Ave
Indianola, MS 38751-2461
Phone
(662) 741-2151
Fax
(662) 741-2700
NPI assigned
Mar 18, 2014
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 A. Fairman
Title
Chief Executive Officer
Phone
(662) 741-8880

Specialties & licenses 1

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

Addresses

Primary practice location

118 Front Ave
Indianola, MS 38751-2461

Mailing address

702 Martin Luther King St
Mound Bayou, MS 38762-9314
Phone (662) 741-2151

Medicare participation

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

Enrollment records 2

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…
O20140625000124 MS Part A Provider - Federally Qualified Health Center (FQHC) 6608783295 Practice locations: Indianola, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1629495452. Details of each certification follow.

Federally qualified health center certification: CCN 251022

Legal name
DELTA HEALTH CENTER, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 25, 2014
Last certification
Jun 25, 2014
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 27, 1967 in MS
Enrollment address
118 Front Ave
Indianola, MS 38751-2461

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

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

102 S Martin Luther King Jr Dr
Indianola, MS 38751
Phone (662) 445-0900

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
John a Fairman Individual Corporate OfficerCeo Nov 1, 2013 100%
W-2 Managing EmployeeCeo Nov 1, 2013 100%
Hazel D Whiting Individual W-2 Managing EmployeeCfo Nov 1, 2013

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 5

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": "1395100800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1751932800000",
    "number": "1629495452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "702 MARTIN LUTHER KING ST",
            "city": "MOUND BAYOU",
            "state": "MS",
            "postal_code": "387629314",
            "telephone_number": "662-741-2151",
            "fax_number": "662-741-2700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "118 FRONT AVE",
            "city": "INDIANOLA",
            "state": "MS",
            "postal_code": "387512461",
            "telephone_number": "662-741-2151",
            "fax_number": "662-741-2700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DELTA HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-18",
        "last_updated": "2025-07-08",
        "certification_date": "2025-07-08",
        "status": "A",
        "authorized_official_last_name": "FAIRMAN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "662-741-8880",
        "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": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianola, MS

Sources for this page

Verify at the official NPI Registry.