Organization
DELTA CONCIERGE MEDICINE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH KELLOUGH (CHIEF EXECUTIVE OFFICER)
(662) 621-2192
Entity
Organization
Contact information
Practice address
705 N STATE ST, CLARKSDALE, MS 38614-6519
(662) 621-2192
Mailing address
PO BOX 1930, CLARKSDALE, MS 38614-7930
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
16776
MS
Other
Enumeration date
09/29/2011
Last updated
09/29/2011
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