Provider Demographics
NPI:1871628354
Name:DELTA MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:DELTA MEMORIAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SKYE
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-382-4303
Mailing Address - Street 1:811 HWY 65 SOUTH
Mailing Address - Street 2:
Mailing Address - City:DUMAS
Mailing Address - State:AR
Mailing Address - Zip Code:71639
Mailing Address - Country:US
Mailing Address - Phone:870-382-4303
Mailing Address - Fax:870-382-6555
Practice Address - Street 1:811 HWY 65 SOUTH
Practice Address - Street 2:
Practice Address - City:DUMAS
Practice Address - State:AR
Practice Address - Zip Code:71639
Practice Address - Country:US
Practice Address - Phone:870-382-4303
Practice Address - Fax:870-382-6555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR4296261QR1300X
ARAR4392261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health