1720497936 NPI number — QUALITY MEDICAL CLINIC, INC.

Table of content: PATRICK SCOTT MCCOY LCMFT (NPI 1245947944)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720497936 NPI number — QUALITY MEDICAL CLINIC, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
QUALITY MEDICAL CLINIC, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720497936
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/08/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
120 5TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MCCOMB
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39648-4159
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-444-9266
Provider Business Mailing Address Fax Number:
601-444-9267

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1212 BROAD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39429-3114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-444-9266
Provider Business Practice Location Address Fax Number:
601-444-9267
Provider Enumeration Date:
08/13/2014

Additional Information

Authorized Official

Authorized Official Last Name:
ANAZIA
Authorized Official First Name:
VICTOR
Authorized Official Middle Name:
O
Authorized Official Title or Position:
AUTHORIZED AGENT
Authorized Official Telephone Number:
601-444-9266

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  14997 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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