DELTA MEDICAL GROUP NPI 1790701134

NPI Information

  • NPI: 1790701134
  • Provider Name: DELTA MEDICAL GROUP
  • Classification: Emergency Medicine - 207P00000X
  • Entity Type: Organization
  • CLIA Number: 25D0971010
  • Address: 1693 FAIRGROUNDS RD
    GREENVILLE, MS
    ZIP 38703
  • Phone: (662) 725-2749

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NPI Details

DELTA MEDICAL GROUP is an emergency medicine in Greenville, MS. The provider is an emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury. DELTA MEDICAL GROUP NPI is 1790701134. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

1693 FAIRGROUNDS RD
GREENVILLE, MS
ZIP 38703-810
Phone: (662) 725-2749
Fax: (662) 725-2741

The provider's authorized official is Iris Stacker .
The authorized official title is Ceo and has the following contact phone number (662) 378-3783.

The CLIA number assigned to this NPI record is 25D0971010 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/15/2006 and was last updated on 11/14/2022.

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
1207Q00000XFamily MedicineNo
2207RI0200XInternal MedicineInfectious DiseaseNo
3207RR0500XInternal MedicineRheumatologyNo
4207T00000XNeurological SurgeryNo
5207UN0901XNuclear MedicineNuclear CardiologyNo
6207V00000XObstetrics & GynecologyNo
7207X00000XOrthopaedic SurgeryNo
8208000000XPediatricsNo
9208200000XPlastic SurgeryNo
102084N0400XPsychiatry & NeurologyNeurologyNo
112085R0202XRadiologyDiagnostic RadiologyNo
12208600000XSurgeryNo
13208G00000XThoracic Surgery (Cardiothoracic Vascular Surgery)No
14363L00000XNurse PractitionerNo
15207P00000XEmergency MedicineYes

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
1156272002MEDICAIDARKANSAS
209015100MEDICAIDMISSISSIPPI

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: 11/21/2025

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