Provider Demographics
NPI:1972566313
Name:MCCOY, JAMES ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ANDREW
Last Name:MCCOY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 COON RAPIDS BLVD
Mailing Address - Street 2:FAMILY LIFE MENTAL HEALTH CENTER
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433
Mailing Address - Country:US
Mailing Address - Phone:763-746-9583
Mailing Address - Fax:763-746-9597
Practice Address - Street 1:1930 COON RAPIDS BLVD
Practice Address - Street 2:FAMILY LIFE MENTAL HEALTH CENTER
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433
Practice Address - Country:US
Practice Address - Phone:763-427-7964
Practice Address - Fax:763-427-7976
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN400692084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
260043628OtherRR MEDICARE
MN31Q03MCOtherBCBS
HP38126OtherHEALTH PARTNERS
MN1023455OtherPREFERRED ONE
MN938368900Medicaid
121687OtherUCARE
1553244OtherUBH
E91072Medicare UPIN
MN938368900Medicaid