| Quality Medical Clinic, Inc. | |
|
1212 Broad St Columbia MS 39429-3114 | |
| (601) 444-9266 | |
| (601) 444-9267 |
| Full Name | Quality Medical Clinic, Inc. |
|---|---|
| Speciality | Internal Medicine |
| Location | 1212 Broad St, Columbia, Mississippi |
| Authorized Official Name and Position | Victor O Anazia (AUTHORIZED AGENT) |
| Authorized Official Contact | 6014449266 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Quality Medical Clinic, Inc. 120 5th Ave Mccomb MS 39648-4159 Ph: (601) 444-9266 | Quality Medical Clinic, Inc. 1212 Broad St Columbia MS 39429-3114 Ph: (601) 444-9266 |
| NPI Number | 1720497936 |
|---|---|
| Provider Enumeration Date | 08/13/2014 |
| Last Update Date | 10/08/2014 |
| Medicare PECOS PAC ID | 4688998172 |
|---|---|
| Medicare Enrollment ID | O20150109000472 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720497936 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 14997 (Mississippi) | Primary |
| Provider Name | Victor O Anazia |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1245232792 PECOS PAC ID: 3476447996 Enrollment ID: I20040216000222 |
| Provider Name | Robert W Watson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1669413233 PECOS PAC ID: 5294762373 Enrollment ID: I20050720000566 |
| Provider Name | Harry G Hunt |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1346268786 PECOS PAC ID: 8527124239 Enrollment ID: I20090819000630 |
| Provider Name | Shakita D Rawls |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275043127 PECOS PAC ID: 5991046740 Enrollment ID: I20190404002656 |
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