Provider Demographics
NPI:1720497936
Name:QUALITY MEDICAL CLINIC, INC.
Entity Type:Organization
Organization Name:QUALITY MEDICAL CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED AGENT
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:O
Authorized Official - Last Name:ANAZIA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:601-444-9266
Mailing Address - Street 1:120 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39648-4159
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:2014-08-13
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS14997207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty