MEDICARE: MEDCOY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	OS2972	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366604431
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDCOY INC

Provider Business Mailing Address
First Line	:	11512 E COUNTY ROAD 316
Second Line	:	PO BOX 2220
City	:	FORT MC COY
State	:	FL
Zip	:	32134-2220
Country	:	US
Telephone Number	:	352-236-2525
Fax Number	:	325-236-8610

Provider Business Practice Location Address
First Line	:	11512 E COUNTY ROAD 316
Second Line	:
City	:	FT MCCOY
State	:	FL
Zip	:	32134-2220
Country	:	US
Telephone Number	:	352-236-2525
Fax Number	:	352-236-8610

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GEORGE F GRAVES
Credential	:	D.O
Telephone Number	:	352-236-2525

Provider Enumeration Date	:	06/30/2008
Last Update Date	:	09/09/2008

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Directions to “MEDCOY INC ” Practice Location

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