Provider Demographics
NPI:1821480807
Name:JACK R MCCOY
Entity Type:Organization
Organization Name:JACK R MCCOY
Other - Org Name:MEADOW SPRINGS OF GREENWOOD, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-414-4789
Mailing Address - Street 1:6000 S 150 W
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47909-8909
Mailing Address - Country:US
Mailing Address - Phone:765-414-4789
Mailing Address - Fax:405-603-2207
Practice Address - Street 1:2049 VETERANS MEMORIAL PKWY S
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47909-9362
Practice Address - Country:US
Practice Address - Phone:765-464-6370
Practice Address - Fax:765-464-6267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-26
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment