Organization
DELTA SPECIALTY CLINIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KATHERINE COLBERT CPC (ADMINISTRATOR)
(662) 332-8848
Entity
Organization
Contact information
Practice address
930 MAIN ST, GREENVILLE, MS 38701-4111
(662) 332-8848
(662) 332-8854
Mailing address
PO BOX 4577, GREENVILLE, MS 38704-4577
(662) 332-8848
(662) 332-8854
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
18512
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05828295
—
MS
Enumeration date
11/01/2012
Last updated
11/07/2012
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