Provider Demographics
NPI:1588664940
Name:MEDICOMP INC
Entity Type:Organization
Organization Name:MEDICOMP INC
Other - Org Name:REACTDX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDIENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:BALDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-676-0010
Mailing Address - Street 1:600 ATLANTIS RD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-2315
Mailing Address - Country:US
Mailing Address - Phone:321-676-0010
Mailing Address - Fax:866-294-3975
Practice Address - Street 1:600 ATLANTIS RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-2315
Practice Address - Country:US
Practice Address - Phone:321-676-0010
Practice Address - Fax:866-294-3975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-28
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
No293D00000XLaboratoriesPhysiological LaboratoryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3283728OtherAETNA PROVIDER#
FLV2230OtherBLUE CROSS PROVIDER #
FL470001771OtherPALMETTO GBA#
FLV2230OtherBLUE CROSS PROVIDER #