NPI 1174642144 · live from the CMS NPI Registry
Delta Physician Practices
Internal Medicine, Gastroenterology in Greenville, MS. National Provider Identifier 1174642144, active.
NPI record
| NPI | 1174642144 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Internal Medicine, Gastroenterology 207RG0100X |
| Practice location | 1502 S Colorado St, Greenville, MS 38703 |
| Practice phone | 662-332-9872 |
| Mailing address | Po Box 23998, Jackson, MS 39225 |
| Enumerated | March 28, 2007 |
| Last updated | November 4, 2022 |
| Authorized official | Iris Stacker, Ceo |
| Other names | Delta Health-Greenville Medical Group |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Nurse Practitioner | 363L00000X | — |
| Internal Medicine, Gastroenterology primary | 207RG0100X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.