MEDICARE: NEIL W KOOY M.D.

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	2080P0203X	Pediatric Critical Care Medicine Physician	20713	TN

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689626343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NEIL W KOOY M.D.

Provider Business Mailing Address
First Line	:	408 N STATE OF FRANKLIN RD
Second Line	:	SUITE 31D
City	:	JOHNSON CITY
State	:	TN
Zip	:	37604-6089
Country	:	US
Telephone Number	:	423-431-4946
Fax Number	:	423-431-4947

Provider Business Practice Location Address
First Line	:	408 N STATE OF FRANKLIN RD
Second Line	:	SUITE 31D
City	:	JOHNSON CITY
State	:	TN
Zip	:	37604-6089
Country	:	US
Telephone Number	:	423-431-4946
Fax Number	:	423-431-4947

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

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	02/15/2017

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Directions to “ NEIL W KOOY M.D.” Practice Location

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