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NPI Code Detail

MEDICARE: COMP MED INC.

MEDICARE: COMP MED INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1194787671
Entity Type Code : Organization
Provider Name (Legal Business Name) : COMP MED INC.
Provider Business Mailing Address
First Line : PO BOX 637
Second Line :
City : ORANGE PARK
State : FL
Zip : 32067-0637
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 159 N 3RD ST
Second Line :
City : MACCLENNY
State : FL
Zip : 32063-2103
Country : US
Telephone Number : 904-259-7185
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : MARK HARDIN
Credential : DO
Telephone Number : 904-259-7815
Provider Enumeration Date : 04/03/2006
Last Update Date : 03/20/2008

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Directions to “COMP MED INC. ” Practice Location

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