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General NPI Number Information
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NPI Number | 1588841308
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Entity Type | Organization
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Legal Business Name | GLENN A. MCCOY, MD PLLC
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Dates
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Enumeration Date | 01/23/2008
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Last Update Date | 11/05/2010
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Provider Practice Location Address
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Address Line | 1700 BLUEGRASS AVENUE SUITE 110
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City | LOUISVILLE
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State | KY
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Zip | 40215-1129
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Country | US
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Telephone | 502-368-3056
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Fax | 502-363-1627
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Provider Business Mailing Address
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Address Line | 1700 BLUEGRASS AVENUE SUITE 110
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City | LOUISVILLE
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State | KY
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Zip | 40215
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Country | US
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Telephone | 502-368-3056
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Fax | 502-363-1627
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GLENN A MCCOY
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Credential | M.D.
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Telephone | 502-368-3056
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 23946
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License Number State | KY
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