Provider Demographics
NPI:1336509728
Name:MEDICOMP, INC.
Entity Type:Organization
Organization Name:MEDICOMP, INC.
Other - Org Name:MEDICOMP PHYSICAL THERAPY PEARL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:S
Authorized Official - Last Name:MCNULTY
Authorized Official - Suffix:III
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 1:3454 HIGHWAY 80 E
Practice Address - Street 2:
Practice Address - City:PEARL
Practice Address - State:MS
Practice Address - Zip Code:39208-4001
Practice Address - Country:US
Practice Address - Phone:601-824-8914
Practice Address - Fax:601-824-8828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-29
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy