| Delta Health Center, Inc. | |
|
100 East Washington Street Hollandale MS 38748 | |
| (662) 741-8800 | |
| (662) 741-2700 |
| Full Name | Delta Health Center, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 100 East Washington Street, Hollandale, Mississippi |
| Authorized Official Name and Position | John A. Fairman (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 6627418880 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Delta Health Center, Inc. 100 East Washington Street Hollandale MS 38748 Ph: (662) 741-8800 | Delta Health Center, Inc. 100 East Washington Street Hollandale MS 38748 Ph: (662) 741-8800 |
| NPI Number | 1316314396 |
|---|---|
| Provider Enumeration Date | 08/26/2015 |
| Last Update Date | 10/12/2016 |
| Medicare PECOS PAC ID | 6608783295 |
|---|---|
| Medicare Enrollment ID | O20160201002672 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316314396 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Mississippi) | Primary |