Organization
DELTA HEART & VASCULAR CENTER, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN L HERZOG (CEO/MD)
(662) 335-0183
Entity
Organization
Contact information
Practice address
1421 E UNION ST, GREENVILLE, MS 38703-3247
(662) 335-0183
(662) 335-7184
Mailing address
1421 E UNION ST, GREENVILLE, MS 38703-3247
(662) 335-0183
(662) 335-7184
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
190990002
—
AR
05
—
9016026
—
MS
01
—
DA3016
RAILROAD MEDICARE
MS
Enumeration date
11/22/2005
Last updated
05/20/2021
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