MEDICARE: EMERY BRAD MCCOY D.O., PLLC

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	207R00000X	Internal Medicine Physician	1953	WV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	1477665768	OTHER	WV	MEDICARE RAILROAD

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	:	1477665768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMERY BRAD MCCOY D.O., PLLC

Provider Business Mailing Address
First Line	:	3761A TEAYS VALLEY ROAD
Second Line	:
City	:	HURRICANE
State	:	WV
Zip	:	25526-9705
Country	:	US
Telephone Number	:	304-760-8721
Fax Number	:	304-760-8722

Provider Business Practice Location Address
First Line	:	3761A TEAYS VALLEY ROAD
Second Line	:
City	:	HURRICANE
State	:	WV
Zip	:	25526-9705
Country	:	US
Telephone Number	:	304-760-8721
Fax Number	:	304-760-8722

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	06/01/2020

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