Organization
DELTA MEDICAL SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DORIS MITCHELL (PRESIDENT/CEO)
(318) 459-1600
Entity
Organization
Contact information
Practice address
1800 BUCKNER ST, SUITE B210, SHREVEPORT, LA 71101-4440
(318) 459-1600
Mailing address
1800 BUCKNER ST, SUITE B210, SHREVEPORT, LA 71101-4440
Taxonomy
Speciality
Code
Description
License number
State
251T00000X
PACE Provider Organization
Primary
11385
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1172367
—
LA
05
—
1368431
—
LA
05
—
1369403
—
LA
05
—
1566331
—
LA
Enumeration date
01/30/2008
Last updated
01/30/2008
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