# DELTA MEDICAL FOUNDATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** CLARKSDALE FAM MED CENTER
- **Organization subpart:** No

## Provider details

- **NPI number:** 1467949941
- **Authorized official:** LONNIE MOORE (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (662) 326-3500

## Contact information

- **Practice address:** 1209 LEE DR, CLARKSDALE, MS 38614-3320
- **Practice address phone:** (662) 326-3500
- **Practice address fax:** (662) 326-7077
- **Mailing address:** PO BOX 289, MARKS, MS 38646-0289
- **Mailing address phone:** (662) 398-5111
- **Mailing address fax:** (662) 398-7123

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 261QR1300X | Rural Health Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 04/19/2018
- **Last updated:** 03/01/2023