Provider Demographics
NPI:1750614582
Name:MCCOY, MEGHAN E (PA)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:E
Last Name:MCCOY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 SOUTH 7TH ST
Mailing Address - Street 2:PURPLE BUILDING, LEVEL 7
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415
Mailing Address - Country:US
Mailing Address - Phone:612-873-6963
Mailing Address - Fax:
Practice Address - Street 1:716 SOUTH 7TH ST
Practice Address - Street 2:PURPLE BUILDING, LEVEL 7
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415
Practice Address - Country:US
Practice Address - Phone:612-873-6963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-11
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085003560363A00000X
MN2068363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0533210001Medicare NSC
ILIL3270066Medicare PIN
IL6447860011Medicare NSC