Delta Physician Practices

Organization Active NPI Obstetrics & Gynecology Physician · Greenville, MS

NPI 1891814802 · NPPES record last updated Nov 14, 2022

Key facts

NPI
1891814802
Entity type
Organization (NPI type 2)
Primary specialty
Obstetrics & Gynecology Physician 207V00000X
Legal business name
DELTA PHYSICIAN PRACTICES
Practice address
302 Arnold Ave
Greenville, MS 38701-4711
Phone
(662) 335-8919
Fax
(662) 335-2091
NPI assigned
Mar 29, 2007
Organization subpart
Yes
Parent organization (as reported)
DELTA PHSICIAN PRACTICES

Authorized official

Name
Iris Stacker
Title
Ceo
Phone
(662) 378-3783

Corporate family (same tax ID) 14

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

Practitioners 9

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

National Provider Directory

Tax ID family
Delta Regional Medical (15 organizations share this tax ID)
Part of
Delta Regional Medical

Locations

302 Arnold Ave
Greenville, MS 38701
Phone (662) 335-2093

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician
Group: 193200000X MULTI-SPECIALTY GROUP
207V00000X Yes
Obstetrics & Gynecology Nurse Practitioner
Group: 193200000X MULTI-SPECIALTY GROUP
363LX0001X

Addresses

Primary practice location

302 Arnold Ave
Greenville, MS 38701-4711

Mailing address

PO Box 23998
Jackson, MS 39225-3998
Phone (662) 725-2749

Other identifiers

IdentifierTypeStateIssuer
156272002MedicaidAR
09015100MedicaidMS

Other providers in Greenville, MS

All providers in Greenville, MS · Obstetrics & Gynecology Physician in Mississippi

Sources for this page

Verify at the official NPI Registry.