Provider Demographics
NPI:1497393912
Name:AARON B MCCOY CRNA PC
Entity Type:Organization
Organization Name:AARON B MCCOY CRNA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:B
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-CRNA
Authorized Official - Phone:580-490-6410
Mailing Address - Street 1:PO BOX 101
Mailing Address - Street 2:
Mailing Address - City:SPRINGER
Mailing Address - State:OK
Mailing Address - Zip Code:73458-0101
Mailing Address - Country:US
Mailing Address - Phone:580-490-6410
Mailing Address - Fax:
Practice Address - Street 1:2002 12TH AVE NW STE C
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-1206
Practice Address - Country:US
Practice Address - Phone:580-224-0007
Practice Address - Fax:580-223-7140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-16
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty