Provider Demographics
NPI:1760602627
Name:MEDCORP PLC, INC.
Entity Type:Organization
Organization Name:MEDCORP PLC, INC.
Other - Org Name:MEDCORP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:
Authorized Official - First Name:YVENY
Authorized Official - Middle Name:N
Authorized Official - Last Name:PETITHOMME
Authorized Official - Suffix:II
Authorized Official - Credentials:PHD
Authorized Official - Phone:561-305-5000
Mailing Address - Street 1:PO BOX 3465
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33402
Mailing Address - Country:US
Mailing Address - Phone:561-305-5000
Mailing Address - Fax:561-381-4210
Practice Address - Street 1:5300 W ATLANTIC AVE
Practice Address - Street 2:SUITE 505
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-8165
Practice Address - Country:US
Practice Address - Phone:561-305-5000
Practice Address - Fax:561-381-4210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHHA299991346251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108016Medicare ID - Type Unspecified