Provider Demographics
NPI:1316900962
Name:MID-DELTA HOSPICE SOUTH INC
Entity type:Organization
Organization Name:MID-DELTA HOSPICE SOUTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:MAURICIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-325-0175
Mailing Address - Street 1:PO BOX 373
Mailing Address - Street 2:405 N. HAYDEN STREET
Mailing Address - City:BELZONI
Mailing Address - State:MS
Mailing Address - Zip Code:39038-0373
Mailing Address - Country:US
Mailing Address - Phone:662-247-1254
Mailing Address - Fax:662-247-4924
Practice Address - Street 1:711 BROOKWAY BLVD STE B
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:MS
Practice Address - Zip Code:39601-2639
Practice Address - Country:US
Practice Address - Phone:601-990-5002
Practice Address - Fax:662-247-4924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-06
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS120251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS251616Medicare ID - Type Unspecified