Provider Demographics
NPI:1285951970
Name:DELTA HEALTH CENTER, INC
Entity type:Organization
Organization Name:DELTA HEALTH CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:FAIRMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-741-8880
Mailing Address - Street 1:702 MARTIN LUTHER KING ROAD
Mailing Address - Street 2:POST OFFICE BOX 900
Mailing Address - City:MOUND BAYOU
Mailing Address - State:MS
Mailing Address - Zip Code:38762-0900
Mailing Address - Country:US
Mailing Address - Phone:662-741-8880
Mailing Address - Fax:662-741-8882
Practice Address - Street 1:548 ROSEMARY ROAD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:MS
Practice Address - Zip Code:38732-2075
Practice Address - Country:US
Practice Address - Phone:662-843-7299
Practice Address - Fax:662-741-8893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-21
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)