Provider Demographics
NPI:1407266539
Name:IWUEKE PSYCHATRIC CLINIC
Entity Type:Organization
Organization Name:IWUEKE PSYCHATRIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHIKA
Authorized Official - Middle Name:U
Authorized Official - Last Name:IWUEKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-840-7800
Mailing Address - Street 1:1601 W MAIN ST STE D
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-3300
Mailing Address - Country:US
Mailing Address - Phone:662-840-7800
Mailing Address - Fax:662-842-8899
Practice Address - Street 1:1601 W MAIN ST STE D
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-3300
Practice Address - Country:US
Practice Address - Phone:662-840-7800
Practice Address - Fax:662-842-8899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-29
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD469722084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty