NPIMap

Delta Health Center, Inc

Organization Active NPI Federally Qualified Health Center (FQHC) · Indianola, MS

NPI 1881240752 · NPPES record last updated Jul 8, 2025

Key facts

NPI
1881240752
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name
DELTA HEALTH CENTER, INC
Practice address
404 Jefferson St
Indianola, MS 38751-3265
Phone
(662) 884-1250
Fax
(662) 887-7086
NPI assigned
Aug 15, 2019
Organization subpart
No

Authorized official

Name
Myrtis Small
Title
HR-Credentialing
Phone
(662) 741-8889

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Other NPIs on the same Medicare enrollment 17

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Other NPIs with the same Medicare PAC ID 17

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Corporate family (same tax ID) 33

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

View all 33

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
25D2171528Delta Health Center Carver Elementary
404 Jefferson Street, Indianola, MS 38751		Certificate of waiverSep 2, 2027

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in MS

Federally qualified health center certification: CCN 251094

Legal name
DELTA HEALTH CENTER, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 9, 2019
Last certification
Oct 9, 2019
Ownership / control type
For profit – partnership
Organization structure
Corporation · Non-profit
Incorporated
Feb 27, 1967 in MS
Enrollment address
404 Jefferson Street
Indianola, MS 38751-3265

All disclosed owners & managing parties 1

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 Officer
Ceo		 Aug 1, 2009
W-2 Managing Employee
Ceo		 Aug 1, 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-Leland
Leland, MS · CCN 251113		 Federally qualified health center Operational/Managerial Control (100%) Aug 1, 2009
DHC -Mvsu
Itta Bena, MS · CCN 251117		 Federally qualified health center Operational/Managerial Control (100%) Aug 1, 2009

Medicare enrollment records

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…
O20191016000290 MS Part a Provider - Federally Qualified Health Center (FQHC) 6608783295 Practice locations: Indianola, MS

National Provider Directory

Tax ID family
Women Pediatric Clinic (34 organizations share this tax ID)

Specialties & licenses

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

Addresses

Primary practice location

404 Jefferson St
Indianola, MS 38751-3265

Mailing address

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

Other names

  • Dhc-Carver Elementary School Doing business as

Other providers in Indianola, MS

All providers in Indianola, MS · Federally Qualified Health Center (FQHC) in Mississippi

Sources for this page

Verify at the official NPI Registry.