Provider Demographics
NPI:1669837241
Name:MEDICOMP, INC.
Entity Type:Organization
Organization Name:MEDICOMP, INC.
Other - Org Name:MEDICOMP PHYSICAL THERAPY PATRICK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNULTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-849-6440
Mailing Address - Street 1:2015 HIGHPOINTE DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042-3169
Mailing Address - Country:US
Mailing Address - Phone:601-824-8914
Mailing Address - Fax:601-824-8828
Practice Address - Street 1:817 WOODLAND DRIVE
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:VA
Practice Address - Zip Code:24171-1559
Practice Address - Country:US
Practice Address - Phone:276-694-3151
Practice Address - Fax:276-694-8655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-23
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy