Provider Demographics
NPI:1073579595
Name:MCCOY, THOMAS F (DO)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:F
Last Name:MCCOY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 N WASHINGTON ST
Mailing Address - Street 2:DEAN MEDICAL CENTER
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53548-2908
Mailing Address - Country:US
Mailing Address - Phone:608-755-3500
Mailing Address - Fax:608-755-3792
Practice Address - Street 1:580 N WASHINGTON ST
Practice Address - Street 2:DEAN MEDICAL CENTER
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53548-2908
Practice Address - Country:US
Practice Address - Phone:608-755-3500
Practice Address - Fax:608-755-3792
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI43448-021208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI9029OtherDEAN HEALTH INSURANCE
WI43493000Medicaid
WI026154340Medicare PIN
WI9029OtherDEAN HEALTH INSURANCE
WI068274150Medicare PIN
WI250012584Medicare PIN