Provider Demographics
NPI:1457738429
Name:MEDICOMP, INC
Entity Type:Organization
Organization Name:MEDICOMP, INC
Other - Org Name:MEDICOMP PHYSICAL THERAPY IUKA
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: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:888-976-2667
Mailing Address - Fax:601-824-8828
Practice Address - Street 1:1112B MARIA LN
Practice Address - Street 2:
Practice Address - City:IUKA
Practice Address - State:MS
Practice Address - Zip Code:38852-1119
Practice Address - Country:US
Practice Address - Phone:888-976-2667
Practice Address - Fax:601-824-8828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-29
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty