NPIMap

Organization Active NPI

Delta Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Mound Bayou, MS
National Provider Identifier
1659378610
Registry record updated Sep 10, 2026
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
702 Martin Luther King Street
Mound Bayou, MS 38762-9314
Phone
(662) 741-2151
Fax
(662) 741-2700
NPI assigned
Jul 6, 2005
Reactivated
Aug 8, 2007
Last updated
Sep 10, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2026

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

Authorized official

Name
Mr. John Fairman, CEO
Title
Ceo
Phone
(662) 741-8800

Specialties & licenses 1

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

Addresses

Primary practice location

702 Martin Luther King Street
Mound Bayou, MS 38762-9314

Mailing address

702 Martin Luther King St
Mound Bayou, MS 38762-9314
Phone (662) 741-8800

Other identifiers 1

IdentifierTypeStateIssuer
09013118MedicaidMS

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
Practice locations: Itta Bena, MS; Ruleville, MS; Rolling Fork, MS; Mound Bayou, MS; Moorhead, MS; Mayersville, MS; Leland, MS; Indianola, MS…
O20101220000904 MS Part A Provider - Federally Qualified Health Center (FQHC) 6608783295 Practice locations: Mound Bayou, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1659378610. Details of each certification follow.

Federally qualified health center certification: CCN 251804

Legal name
DELTA HEALTH CENTER, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 4, 1991
Last certification
Nov 4, 1991
Ownership / control type
Non-profit – other
Organization structure
CorporationNon-profit
Incorporated
Feb 27, 1967 in MS
Enrollment address
702 Martin Luther King St
Mound Bayou, MS 38762-9314

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

Ownership & related parties

All disclosed owners & managing parties 11

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
William Cummings Individual Corporate Director May 27, 2021
Shannon Brown Individual Corporate Director Jan 1, 2008
Joyce Myers Individual Corporate Director Jul 30, 2020
Dorothy Walls Individual Corporate Director Jan 1, 2008
John a Fairman Individual Corporate OfficerCeo Aug 3, 2009 100%
W-2 Managing EmployeeCeo Aug 3, 2009 100%
James Hodges Individual Corporate Director Jan 1, 2005
Shawneequa Beal Individual Corporate Director Jan 1, 2009
Hazel D Whiting Individual Corporate OfficerCfo Oct 19, 2010
W-2 Managing EmployeeCfo Oct 19, 2010

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 41

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.

View all 41

NPI Registry JSON

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

{
    "created_epoch": "1120608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1788998400000",
    "number": "1659378610",
    "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": "662-741-8800",
            "fax_number": "662-741-2700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "702 MARTIN LUTHER KING STREET",
            "city": "MOUND BAYOU",
            "state": "MS",
            "postal_code": "387629314",
            "telephone_number": "662-741-2151",
            "fax_number": "662-741-2700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DELTA HEALTH CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-06",
        "last_updated": "2026-09-10",
        "certification_date": "2026-09-10",
        "deactivation_date": "2007-07-17",
        "reactivation_date": "2007-08-08",
        "status": "A",
        "authorized_official_last_name": "FAIRMAN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "662-741-8800",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CEO"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "MS",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09013118",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mound Bayou, MS

Sources for this page

Verify at the official NPI Registry.