Provider Demographics
NPI:1861612723
Name:MEDCORP PLC, INC.
Entity type:Organization
Organization Name:MEDCORP PLC, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:
Authorized Official - First Name:YVENY
Authorized Official - Middle Name:N
Authorized Official - Last Name:PETITHOMME
Authorized Official - Suffix:II
Authorized Official - Credentials:PHD
Authorized Official - Phone:866-213-1817
Mailing Address - Street 1:PO BOX 3465
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33402
Mailing Address - Country:US
Mailing Address - Phone:866-213-1817
Mailing Address - Fax:561-498-4580
Practice Address - Street 1:3275 W HILLSBORO BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-9536
Practice Address - Country:US
Practice Address - Phone:866-213-1817
Practice Address - Fax:561-498-4580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHHA299991937251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108083Medicare ID - Type Unspecified