Provider Demographics
NPI:1346438389
Name:QUALITY CARE INTERNAL MEDICINE OF NORTH AMERICA
Entity Type:Organization
Organization Name:QUALITY CARE INTERNAL MEDICINE OF NORTH AMERICA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTINS
Authorized Official - Middle Name:THADDEUS
Authorized Official - Last Name:UGWU-DIKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-444-9266
Mailing Address - Street 1:PO BOX 1121
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MS
Mailing Address - Zip Code:39429-1121
Mailing Address - Country:US
Mailing Address - Phone:601-444-9266
Mailing Address - Fax:601-444-9267
Practice Address - Street 1:1212 BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MS
Practice Address - Zip Code:39429-3114
Practice Address - Country:US
Practice Address - Phone:601-444-9266
Practice Address - Fax:601-444-9267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS15631R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09308872Medicaid
MSDN7784OtherRAILROAD MEDICARE
MS408819123BOtherBLUE CROSS BLUE SHIELD MS
MS512G700022Medicare PIN