Healthcare Provider Details

I. General information

NPI: 1144338070
Provider Name (Legal Business Name): MEDICOMP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 02/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1054 GREYMONT AVE
JACKSON MS
39202-2718
US

IV. Provider business mailing address

110 PIONEER WAY
MAGEE MS
39111
US

V. Phone/Fax

Practice location:
  • Phone: 601-355-9624
  • Fax: 601-353-6151
Mailing address:
  • Phone: 601-849-6440
  • Fax: 601-353-6151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH MCNULTY III
Title or Position: CEO
Credential:
Phone: 601-849-6440