Provider Demographics
NPI:1285789677
Name:DELTA GASTROENTEROLOGY P.C.
Entity type:Organization
Organization Name:DELTA GASTROENTEROLOGY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GASTROENTEROLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ULRIC
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-280-8222
Mailing Address - Street 1:9140 HIGHWAY 51 N
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-1233
Mailing Address - Country:US
Mailing Address - Phone:662-280-8222
Mailing Address - Fax:662-280-5541
Practice Address - Street 1:9140 HIGHWAY 51 N
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-1233
Practice Address - Country:US
Practice Address - Phone:662-280-8222
Practice Address - Fax:662-280-5541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3050626OtherBLUECROSS BLUESHIELD
TN3729898Medicaid
TN3050626OtherTENNCARE SELECT
TN3000117OtherTLC
=========OtherCIGNA
TN3000117OtherTLC
TN3729898Medicaid
=========OtherAETNA
TN=========OtherOMNICARE
TN3729898Medicaid
=========OtherCIGNA
MSF96919Medicare UPIN