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General NPI Number Information
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NPI Number | 1780530667
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Entity Type | Individual
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Provider Name | JUSTIN MCCOY RN
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Gender | Male
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Dates
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Enumeration Date | 03/04/2026
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Last Update Date | 03/04/2026
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Provider Practice Location Address
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Address Line | 2825 E BARNETT RD
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City | MEDFORD
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State | OR
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Zip | 97504-8332
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Country | US
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Telephone | 541-789-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 838 OVERCUP ST
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City | MEDFORD
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State | OR
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Zip | 97501-1709
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Country | US
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Telephone | 541-861-1063
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | 201142054RN
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License Number State | OR
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