=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023146669
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MR. RICHARD DAVID MCCOY
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/02/2007
-----------------------------------------------------
Last Update Date | 07/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8111 176TH LN NW
-----------------------------------------------------
City | ANOKA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55303-5570
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 763-441-1278
-----------------------------------------------------
Fax | 763-241-6894
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8111 176TH LN NW
-----------------------------------------------------
City | ANOKA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55303-5570
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 763-441-1278
-----------------------------------------------------
Fax | 763-241-6894
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 237700000X
-----------------------------------------------------
Taxonomy Name | Hearing Instrument Specialist
-----------------------------------------------------
License Number | 2186
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------