Organization
DELTA ENDOSCOPY CENTER, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ULRIC D. DUNCAN M.D. (GASTROENTEROLOGIST)
(662) 280-8222
Entity
Organization
Contact information
Practice address
9140 HIGHWAY 51 N, SOUTHAVEN, MS 38671-1233
(662) 280-8222
(662) 280-5541
Mailing address
9140 HIGHWAY 51 N, SOUTHAVEN, MS 38671-1233
(662) 280-8222
(662) 280-5541
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
15684
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00770356
—
MS
01
—
3134453
BLUECROSS BLUESHIELD TN
MS
01
—
4287022
TENNESEE MEDICAID
MS
Enumeration date
05/25/2006
Last updated
04/20/2008
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