Provider Demographics
NPI:1841491404
Name:DELTA ASTHMA & ALLERGY
Entity type:Organization
Organization Name:DELTA ASTHMA & ALLERGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:B
Authorized Official - Last Name:BROOME
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-378-2762
Mailing Address - Street 1:2335 HIGHWAY 1 S
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38701-8337
Mailing Address - Country:US
Mailing Address - Phone:662-378-2762
Mailing Address - Fax:662-378-9573
Practice Address - Street 1:2335 HIGHWAY 1 S
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38701-8337
Practice Address - Country:US
Practice Address - Phone:662-378-2762
Practice Address - Fax:662-378-9573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS12482207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS587763099BOtherBLUE CROSS OF MS
MS09015689Medicaid
MS587763099OtherTRICARE
MS587763099OtherTRICARE