MEDICARE: LORI K MCCOY R.N.

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
1	163WC0400X	Case Management Registered Nurse	RN-196532	OH
2	163WH0200X	Home Health Registered Nurse	RN-196532	OH
3	163WH1000X	Hospice Registered Nurse	RN-196532	OH
4	163WP0200X	Pediatric Registered Nurse	RN-196532	OH
5	163WX0200X	Oncology Registered Nurse	RN196532	OH

General Provider Information

NPI Number	:	1407170152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI K MCCOY R.N.

Provider Business Mailing Address
First Line	:	3044 DREWERSBURG RD
Second Line	:
City	:	WEST HARRISON
State	:	IN
Zip	:	47060-9641
Country	:	US
Telephone Number	:	812-637-9906
Fax Number	:

Provider Business Practice Location Address
First Line	:	3044 DREWERSBURG RD
Second Line	:
City	:	WEST HARRISON
State	:	IN
Zip	:	47060-9641
Country	:	US
Telephone Number	:	812-637-9906
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2010
Last Update Date	:	03/24/2010

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