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? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty |