| Delta Health Center Inc | |
|
702 Martin Luther King Road Mound Bayou MS 38762-9314 | |
| (662) 741-2151 | |
| (662) 741-2700 |
| Full Name | Delta Health Center Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 702 Martin Luther King Road, Mound Bayou, Mississippi |
| Authorized Official Name and Position | John Fairman (CEO) |
| Authorized Official Contact | 6627412151 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Delta Health Center Inc 702 Martin Luther King St Post Office Box 900 Mound Bayou MS 38762-0900 Ph: (662) 741-2151 | Delta Health Center Inc 702 Martin Luther King Road Mound Bayou MS 38762-9314 Ph: (662) 741-2151 |
| NPI Number | 1659378610 |
|---|---|
| Provider Enumeration Date | 07/06/2005 |
| Last Update Date | 07/21/2022 |
| Medicare PECOS PAC ID | 6608783295 |
|---|---|
| Medicare Enrollment ID | O20040216000676 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659378610 | NPI | - | NPPES |
| 09013118 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Mississippi) | Primary |
| Provider Name | Frank A Brown |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1841200771 PECOS PAC ID: 1456366822 Enrollment ID: I20060207000706 |
| Provider Name | Penny B Vance |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588690689 PECOS PAC ID: 9436153665 Enrollment ID: I20060831000135 |
| Provider Name | Jenny C Kurts |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821153388 PECOS PAC ID: 5294818779 Enrollment ID: I20080206000492 |
| Provider Name | Ajay A Acharya |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1831201862 PECOS PAC ID: 0648349902 Enrollment ID: I20080513000597 |
| Provider Name | Felicia N White |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457631053 PECOS PAC ID: 5395918973 Enrollment ID: I20111026000523 |
| Provider Name | Valerie O Antici |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700125002 PECOS PAC ID: 2961648415 Enrollment ID: I20130429000503 |
| Provider Name | Alyssa L Simmons |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831523620 PECOS PAC ID: 8426289281 Enrollment ID: I20140320001823 |
| Provider Name | Sherrica Sherrell Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568814655 PECOS PAC ID: 9931478385 Enrollment ID: I20170628003084 |
| Provider Name | Marketta Renea Blue |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1548671514 PECOS PAC ID: 9335463207 Enrollment ID: I20170914002192 |
| Provider Name | Kirsten V Westerfield |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1467999318 PECOS PAC ID: 3779858063 Enrollment ID: I20171012002597 |
| Provider Name | Beverly B Livingston |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861903692 PECOS PAC ID: 5991060196 Enrollment ID: I20180517000134 |
| Provider Name | Lauren M Adams |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1669611745 PECOS PAC ID: 6305903444 Enrollment ID: I20190117000295 |
| Provider Name | Nadia N Bethley |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1649759309 PECOS PAC ID: 9537408737 Enrollment ID: I20190306001401 |
| Provider Name | Lachanda M Brown |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588141725 PECOS PAC ID: 7911230354 Enrollment ID: I20190617003228 |
| Provider Name | Queeneice B Ganison |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437621323 PECOS PAC ID: 5799016069 Enrollment ID: I20191017001998 |
| Provider Name | Bobbie Kay Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861050437 PECOS PAC ID: 2567898679 Enrollment ID: I20200210001658 |
| Provider Name | Sharron S Moore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568002145 PECOS PAC ID: 1759700677 Enrollment ID: I20200925002537 |
| Provider Name | Regina J Evans |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609416544 PECOS PAC ID: 5991124562 Enrollment ID: I20200930003267 |
| Provider Name | Tomeka R Wright Little |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609499904 PECOS PAC ID: 7315367968 Enrollment ID: I20201020001735 |
| Provider Name | Braveen Ragunanthan |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1720513237 PECOS PAC ID: 8527480854 Enrollment ID: I20210908003412 |
| Provider Name | Nina Woolley Ragunanthan |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1629501572 PECOS PAC ID: 7214204742 Enrollment ID: I20211004002054 |
| Provider Name | Quotasze Williams |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1932834231 PECOS PAC ID: 5597140160 Enrollment ID: I20220917000548 |
| Provider Name | Simone Moore |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1730602806 PECOS PAC ID: 1052684479 Enrollment ID: I20230215003082 |
| Provider Name | Alix Henry Sanders |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1568782274 PECOS PAC ID: 0446623672 Enrollment ID: I20230308002078 |
| Provider Name | Jose Abraham Rodriguez |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1780779579 PECOS PAC ID: 6709251986 Enrollment ID: I20230403000121 |
| Provider Name | Clarke Monet Allen |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1578213252 PECOS PAC ID: 0840674206 Enrollment ID: I20230705002690 |
| Provider Name | Barbara H Williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922875228 PECOS PAC ID: 2062865918 Enrollment ID: I20240127000410 |
Delta Health Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 702 Martin Luther King St, Mound Bayou, MS 38762 Phone: 662-741-2151 Fax: 662-741-2339 | |
Delta Health Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 702 Martin Luther King Road, Mound Bayou, MS 38762 Phone: 662-741-2151 | |
Delta Health Center, Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 702 Martin Luther King St, Mound Bayou, MS 38762 Phone: 662-741-2151 Fax: 662-741-2668 | |
Delta Health Center, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 702 Martin Luther King Road, Mound Bayou, MS 38762 Phone: 662-741-2151 | |
Delta Health Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 702 Martin Luther King St, Mound Bayou, MS 38762 Phone: 662-741-2151 Fax: 662-741-2339 | |
Delta Health Center Mscan Hospital Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 702 Martin Luther King St, Mound Bayou, MS 38762 Phone: 662-741-8882 Fax: 662-741-8871 | |
Delta Health Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 702 Martin Luther King St, Mound Bayou, MS 38762 Phone: 662-741-2151 Fax: 662-741-2268 |