Provider Demographics
NPI:1811446248
Name:MEDICOMP INC.
Entity type:Organization
Organization Name:MEDICOMP INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:DUGGAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-824-8914
Mailing Address - Street 1:2015 HIGHPOINTE DRIVE
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 1:710 MAIN STREET
Practice Address - Street 2:SUITE 10
Practice Address - City:COLLINS
Practice Address - State:MS
Practice Address - Zip Code:39428-6293
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:2016-09-27
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center