Provider Demographics
NPI:1912081605
Name:MCCOY, SHELLEY J (MD)
Entity Type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:J
Last Name:MCCOY
Suffix:
Gender:F
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:PO BOX 1498
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69363-1498
Mailing Address - Country:US
Mailing Address - Phone:308-630-7977
Mailing Address - Fax:308-630-1028
Practice Address - Street 1:2 W 42ND STREET
Practice Address - Street 2:SUITE 2800
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-4660
Practice Address - Country:US
Practice Address - Phone:308-630-7977
Practice Address - Fax:308-630-1028
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE21064207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE35049OtherBC/BS PROVIDER NUMBER
NE24554OtherMIDLANDS CHOICE PROVIDER
NE39200784100Medicaid
NE35049OtherBC/BS PROVIDER NUMBER
NE273252Medicare ID - Type Unspecified