Provider Demographics
NPI:1497029912
Name:RONALD C. MCCOY, M.D., PA
Entity Type:Organization
Organization Name:RONALD C. MCCOY, M.D., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:C
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:205-426-6381
Mailing Address - Street 1:P.O BOX 1224
Mailing Address - Street 2:
Mailing Address - City:BESSEMER
Mailing Address - State:AL
Mailing Address - Zip Code:35021
Mailing Address - Country:US
Mailing Address - Phone:205-426-6381
Mailing Address - Fax:205-426-6385
Practice Address - Street 1:1601 SECOND AVENUE NORTH
Practice Address - Street 2:RONALD C. MCCOY,M.D.,PA
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35020-4836
Practice Address - Country:US
Practice Address - Phone:205-426-6381
Practice Address - Fax:205-426-6385
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RONALD C. MCCOY, M.D., PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-01
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6265174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000004143Medicaid
AL000004143Medicaid
AL000004143Medicare PIN