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DELTA GASTROENTEROLOGY P.C. NPI 1285789677


NPI Information

NPI: 1285789677
Provider Name: DELTA GASTROENTEROLOGY P.C.
Classification: Specialist - 174400000X
Entity Type: Organization

CLIA Number: 25D0953294

Address:
9140 HIGHWAY 51 N
SOUTHAVEN, MS
ZIP 38671
Phone: (662) 280-8222
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DELTA GASTROENTEROLOGY P.C. is a specialist in Southaven, MS. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. DELTA GASTROENTEROLOGY P.C. NPI is 1285789677. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

9140 HIGHWAY 51 N
SOUTHAVEN, MS
ZIP 38671-233
Phone: (662) 280-8222
Fax: (662) 280-5541

The provider's authorized official is Ulric Duncan .
The authorized official title is Gastroenterologist and has the following contact phone number (662) 280-8222.

The CLIA number assigned to this NPI record is 25D0953294 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/24/2007 and was last updated on 4/20/2008.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1174400000XSpecialistYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
13000117OTHERTENNESSEETLC
23050626OTHERTENNESSEETENNCARE SELECT
33729898MEDICAIDTENNESSEE
43729898MEDICARE PINTENNESSEE
5=========OTHERMISSISSIPPIBLUECROSS BLUESHIELD
6=========OTHERTENNESSEEOMNICARE
7=========OTHERCIGNA
8=========OTHERUNITED HEALTHCARE
93050626OTHERTENNESSEEBLUECROSS BLUESHIELD
10F96919MEDICARE UPINMISSISSIPPI
11C02805MEDICARE PINMISSISSIPPI
12=========OTHERAETNA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.