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General NPI Number Information
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NPI Number | 1487802567
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Entity Type | Organization
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Legal Business Name | E. BRAD MCCOY, D.O. PLLC
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Dates
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Enumeration Date | 09/03/2008
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Last Update Date | 08/13/2014
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Provider Practice Location Address
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Address Line | 3761 TEAYS VALLEY RD
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City | HURRICANE
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State | WV
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Zip | 25526-9705
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Country | US
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Telephone | 304-760-8721
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Fax | 304-760-8722
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Provider Business Mailing Address
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Address Line | 3761A TEAYS VALLEY RD
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City | HURRICANE
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State | WV
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Zip | 25526-9705
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Country | US
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Telephone | 304-760-8721
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Fax | 304-760-8722
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Authorized Official
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Title or Position | CEO
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Name | E. BRAD MCCOY
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Credential | D.O., PLLC
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Telephone | 304-760-8721
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 1953
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License Number State | WV
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