MMO OF HATTIESBURG LLC NPI 1629022017

NPI Information

  • NPI: 1629022017
  • Provider Name: MMO OF HATTIESBURG, LLC
  • Classification: Clinic/Center - 261QM0801X
  • Specialization: Mental Health (Including Community Mental Health Center)
  • Entity Type: Organization
  • Former Legal Business Name: DELTA MEDICAL SYSTEMS, LLC
  • Address: 990 HARDY ST
    SUITE 4
    HATTIESBURG, MS
    ZIP 39401
  • Phone: (601) 602-0194

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NPI Details

MMO OF HATTIESBURG, LLC is a mental health (including community mental health center) clinic center in Hattiesburg, MS. MMO OF HATTIESBURG, LLC NPI is 1629022017. The provider is registered as an organization entity type.
The provider Former Legal Business Name Is Delta Medical Systems, Llc.

The provider's business location address is:

990 HARDY ST
SUITE 4
HATTIESBURG, MS
ZIP 39401-161
Phone: (601) 602-0194
Fax: (601) 602-0197

The provider's authorized official is Robert L. Miller .
The authorized official title is Ceo and has the following contact phone number (225) 293-6774.

The enumeration date for this NPI number is 5/20/2006 and was last updated on 7/2/2010.

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 Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QM0801XClinic/CenterMental Health (Including Community Mental Health Center)Yes

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 Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1C03576MEDICARE PIN
225-4619MEDICARE PIN

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: 3/30/2025

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