MEDICARE: MCCOY MEDICAL GROUP LLC

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	261QP1100X	Podiatric Clinic/Center

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	:	1700403219
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCCOY MEDICAL GROUP LLC

Provider Business Mailing Address
First Line	:	16590 NE 26TH AVE APT 502
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33160-4072
Country	:	US
Telephone Number	:	703-434-0515
Fax Number	:

Provider Business Practice Location Address
First Line	:	7100 W 20TH AVE STE 515
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33016-1824
Country	:	US
Telephone Number	:	786-644-5248
Fax Number	:	786-644-5475

Authorized Official
Title or Position	:	OWNER
Name	:	ANDREW MCCOY
Credential	:
Telephone Number	:	703-434-0515

Provider Enumeration Date	:	06/30/2020
Last Update Date	:	11/19/2020

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Directions to “MCCOY MEDICAL GROUP LLC ” Practice Location

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