Healthcare Provider Details

I. General information

NPI: 1821221151
Provider Name (Legal Business Name): ROSS EUGENE MCCOY MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2009
Last Update Date: 10/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21825 155TH STREET
BASEHOR KS
66007
US

IV. Provider business mailing address

21825 155TH STREET
BASEHOR KS
66007
US

V. Phone/Fax

Practice location:
  • Phone: 913-416-0522
  • Fax:
Mailing address:
  • Phone: 913-416-0522
  • Fax: 913-724-4900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number7545
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number7601
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: