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DELTA LIFESTYLE SOLUTIONS
NPI 1619579208
Family Medicine in Bridgeport, WV

Active since November 10, 2020CLIA 51D2200928 · Waiver
109 TOLLEY DR, BRIDGEPORT, WV 26330(304) 623-6300(304) 623-6302 Get Directions Write a Review

NPPES record last updated: November 5, 2021. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Nov 5, 2021, Oct 18, 2021, Nov 10, 2020 (3 updates tracked since 2020).

About Delta Lifestyle Solutions NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DELTA LIFESTYLE SOLUTIONS (NPI 1619579208) is a healthcare organization registered as a family medicine in Bridgeport, West Virginia and active in the NPI registry since November 2020. The organization holds a CLIA Waiver certificate valid through November 17, 2026 and lists Mary Hackney, Owner, as its authorized official.

NPPES Registry Identity

NPI1619579208
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameDELTA LIFESTYLE SOLUTIONS
Location Address109 TOLLEY DRBridgeport, WV 26330-1669
Mailing AddressPo Box 4246Clarksburg, WV 26302-4246 · (304) 623-6300
Phone(304) 623-6300
Fax(304) 623-6302
Organization SubpartNo
Authorized OfficialMary HackneyOwner · (304) 623-6300
Enumeration DateNovember 10, 2020
Last NPPES UpdateNovember 5, 20213 updates tracked since enumeration
NPPES CertifiedNovember 5, 2021
✔ NPI 1619579208 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
Also ListedFamily Medicine · Addiction MedicineTaxonomy 207QA0401X
109 TOLLEY DR, Bridgeport, WV 26330
Open in Google Maps ↗

Other Identifiers 1

Medicaid1639326747WV

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Highmark Blue Cross Blue Shield West Virginia.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 51D2200928

Delta Lifestyle LLC · Bridgeport, WV
Active · expires Nov 17, 2026
CLIA Number51D2200928
Laboratory TypePhysician Office
Certificate Effective DateNovember 18, 2024
Certificate Expiration DateNovember 17, 2026
Laboratory DirectorMary E. Hackney
Laboratory Phone(304) 623-6300
Laboratory LocationDelta Lifestyle LLC109 Tolley Drive, Bridgeport, WV 26330
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Delta Lifestyle Solutions's NPI number?

The NPI number for Delta Lifestyle Solutions is 1619579208. It was assigned to this organization in the NPPES registry on November 10, 2020.

Where is Delta Lifestyle Solutions located?

Delta Lifestyle Solutions is located at 109 Tolley Dr, Bridgeport, WV 26330. The listed phone number is (304) 623-6300.

What is Delta Lifestyle Solutions's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Does Delta Lifestyle Solutions hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 51D2200928) is associated with this NPI, valid through November 17, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Delta Lifestyle Solutions accept?

Health plans from Highmark Blue Cross Blue Shield West Virginia list Delta Lifestyle Solutions as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Delta Lifestyle Solutions was last updated on November 5, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.