MEDICARE: MS. LISA MCCOY

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1497648042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LISA MCCOY

Provider Business Mailing Address
First Line	:	260 S STATE ST UNIT 761
Second Line	:
City	:	WESTERVILLE
State	:	OH
Zip	:	43086-9626
Country	:	US
Telephone Number	:	773-754-6673
Fax Number	:

Provider Business Practice Location Address
First Line	:	1306 OAKLAND PARK AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43224-3324
Country	:	US
Telephone Number	:	773-754-6673
Fax Number	:

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

Provider Enumeration Date	:	06/02/2025
Last Update Date	:	06/02/2025

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