Organization
QUALITY CARE INTERNAL MEDICINE OF NORTH AMERICA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARTINS THADDEUS UGWU-DIKE MD (PRESIDENT/OWNER)
(601) 444-9266
Entity
Organization
Contact information
Practice address
1212 BROAD ST, COLUMBIA, MS 39429-3114
(601) 444-9266
(601) 444-9267
Mailing address
PO BOX 1121, COLUMBIA, MS 39429-1121
(601) 444-9266
(601) 444-9267
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
15631R
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09308872
—
MS
01
—
408819123B
BLUE CROSS BLUE SHIELD MS
MS
01
—
DN7784
RAILROAD MEDICARE
MS
Enumeration date
10/03/2007
Last updated
08/09/2010
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