Healthcare Provider Details

I. General information

NPI: 1730276999
Provider Name (Legal Business Name): MEDICOMP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2006
Last Update Date: 06/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 8TH AVE SW
MAGEE MS
39111-3967
US

IV. Provider business mailing address

PO BOX 426
MAGEE MS
39111-0426
US

V. Phone/Fax

Practice location:
  • Phone: 601-849-6440
  • Fax: 601-849-7557
Mailing address:
  • Phone: 601-849-6440
  • Fax: 601-849-7557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSEPH S MCNULTY III
Title or Position: PRESIDENT
Credential: CRT
Phone: 601-849-4112