Provider Demographics
NPI:1598092942
Name:MEDICOMP INC
Entity Type:Organization
Organization Name:MEDICOMP INC
Other - Org Name:REACTDX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
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 1:4000 BLACKBURN LN
Mailing Address - Street 2:SUITE 240
Mailing Address - City:BURTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20866-1104
Mailing Address - Country:US
Mailing Address - Phone:888-432-7818
Mailing Address - Fax:866-294-3975
Practice Address - Street 1:4000 BLACKBURN LN
Practice Address - Street 2:SUITE 240
Practice Address - City:BURTONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20866-1104
Practice Address - Country:US
Practice Address - Phone:888-432-7818
Practice Address - Fax:866-294-3975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-05
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
MD214862Medicare UPIN