MID-DELTA HEALTH SYSTEMS, INC. (NPI# 1053938118) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053938118 |
| Entity Type | Organization |
| Organization Name | MID-DELTA HEALTH SYSTEMS, INC. |
| Practice Address |
1940 S Whitehead Dr De Witt AR 72042-2906 |
| Mailing Address |
245 Madison St Clarendon AR 72029-2706 |
| Practice Telephone | 8709464505 |
| Practice Fax Number | 8709463357 |
| Mailing Telephone | 8707473381 |
| Mailing Fax Number | 8707473631 |
| Enumeration Date | 2020-07-06 |
| Last Update Date | 2020-07-06 |
| Authorized Official Name | REBECCA BROADNAX (AR/BILLING/CRED MANAGER) |
| Authorized Official Telephone | 8707473381 |
| Is Organization Subpart | Y |
| Parent Organization Name | MID-DELTA HEALTH SYSTEMS, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Mid-Delta Health Systems - DeWitt | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285849844 | Mid-delta Health Systems, Inc. | Clinic/Center | 245 Madison St., Clarendon, AR 72029 | 2007-05-14 |
| Street Address |
1940 S WHITEHEAD DR |
| City | DE WITT |
| State | AR |
| Zip Code | 72042-2906 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366438384 | Wallace Lee Tracy | Family Medicine | 1940 S Whitehead Dr, De Witt, AR 72042-2906 | 2005-09-26 |
| 1659319150 | Tracy Family Practice Clinic Pa | Preferred Provider Organization | 1940 S Whitehead Dr, De Witt, AR 72042-2906 | 2006-06-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295839397 | Stanley Wayne Burleson | Family Medicine | 705 W 16th St, Dewitt, AR 72042 | 2006-09-11 |
| 1770796401 | Randall S Hestir Dds Inc | Dentist | 1703 S Whitehead Dr, Dewitt, AR 72042 | 2007-05-08 |
| 1013076397 | James Douglas Allen | Dentist | 1703 S Whitehead Dr, Dewitt, AR 72042 | 2006-12-06 |
| 1780754036 | Randall S Hestir | Dentist | 1703 S Whitehead Dr, Dewitt, AR 72042 | 2006-11-08 |
| 1710207808 | Suzette Nicole Boyd | Nurse Practitioner | 1641 South Whitehead Drive, Dewitt, AR 72042-0000 | 2010-06-11 |
| 1992714992 | Evergreene Properties of North Carolina,llc | Skilled Nursing Facility | 1325 Liberty Drive, Dewitt, AR 72042-0589 | 2006-08-07 |
| 1225328511 | Dewitt School District | Local Education Agency (LEA) | 422 W 1st St, De Witt, AR 72042-1906 | 2011-04-08 |
| 1629376173 | Tiffany N Mcpherson | Counselor | 108 S Jefferson St, De Witt, AR 72042-1929 | 2011-03-08 |
| 1376793406 | Dana's House, Inc. | Foster Care Agency | 108 S Jefferson St, De Witt, AR 72042-1929 | 2008-09-25 |
| 1164550760 | Markallen Behavioral Health System, Inc. | Counselor | 108 S Jefferson St, Dewitt, AR 72042-1929 | 2007-03-02 |
| Find all providers in zip 72042 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
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| 1649814138 | St Francis House Nwa, Inc | Clinic/Center | 2328 Cardinal Drive, Springdale, AR 72764-4469 | 2019-10-29 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.