# DELTA HEALTH SYSTEM

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** DELTA HEALTH-THE MEDICAL CENTER
- **Other names:** Delta Health-Medical Group, Delta Health-Clarksdale Physician Group
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1609464619
- **Legal business name:** DELTA HEALTH-THE MEDICAL CENTER
- **Authorized official:** IRIS STACKER (CHIEF EXECUTIVE OFFICER)
- **Authorized official phone:** (662) 378-3783

## Contact information

- **Practice address:** 785 OHIO AVE STE 2H, CLARKSDALE, MS 38614-6216
- **Practice address phone:** (662) 627-3003
- **Mailing address:** PO BOX 5247, GREENVILLE, MS 38704-5247

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | — | NULL | — |
| 207L00000X | Anesthesiology Physician | — | — | — |
| 207P00000X | Emergency Medicine Physician | — | NULL | — |
| 207P00000X | Emergency Medicine Physician | — | — | — |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |
| 207RG0100X | Gastroenterology Physician | — | NULL | — |
| 207RG0100X | Gastroenterology Physician | — | — | — |
| 207RN0300X | Nephrology Physician | — | NULL | — |
| 207RN0300X | Nephrology Physician | — | — | — |
| 207RP1001X | Pulmonary Disease Physician | — | NULL | — |
| 207RP1001X | Pulmonary Disease Physician | — | — | — |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | — |
| 207X00000X | Orthopaedic Surgery Physician | — | — | — |
| 208000000X | Pediatrics Physician | — | NULL | — |
| 208000000X | Pediatrics Physician | — | — | — |
| 208600000X | Surgery Physician | — | NULL | — |
| 208600000X | Surgery Physician | — | — | — |
| 261QS1200X | Sleep Disorder Diagnostic Clinic/Center | — | NULL | — |
| 367500000X | Certified Registered Nurse Anesthetist | — | NULL | — |
| 367500000X | Certified Registered Nurse Anesthetist | — | — | — |

## Other

- **Enumeration date:** 01/05/2021
- **Last updated:** 11/14/2022