Provider Demographics
NPI:1033385091
Name:MEDCORP INC
Entity Type:Organization
Organization Name:MEDCORP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-727-7000
Mailing Address - Street 1:745 MEDCORP DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43608-1376
Mailing Address - Country:US
Mailing Address - Phone:419-727-7000
Mailing Address - Fax:419-727-8439
Practice Address - Street 1:745 MEDCORP DR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43608-1376
Practice Address - Country:US
Practice Address - Phone:419-727-7000
Practice Address - Fax:419-727-8439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-30
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH06-C-00579-01335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0721026Medicaid
OH0721026Medicaid