1003239872 NPI number — THE MCCOY INSTITUTE OF HEARING AND BALANCE,LLC

Table of content: (NPI 1003239872)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003239872 NPI number — THE MCCOY INSTITUTE OF HEARING AND BALANCE,LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE MCCOY INSTITUTE OF HEARING AND BALANCE,LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MCCOY INSTITUTE OF HEALTH
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003239872
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/26/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1922 UNIVERSITY BLVD S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32216-8933
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-318-3763
Provider Business Mailing Address Fax Number:
904-212-0665

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1922 UNIVERSITY BLVD S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32216-8933
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-318-3763
Provider Business Practice Location Address Fax Number:
904-212-0665
Provider Enumeration Date:
01/29/2014

Additional Information

Authorized Official

Authorized Official Last Name:
MCCOY
Authorized Official First Name:
NATALLA
Authorized Official Middle Name:
S
Authorized Official Title or Position:
CLINICAL DIRECTOR
Authorized Official Telephone Number:
904-864-8594

Provider Taxonomy Codes

  • Taxonomy code: 171000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 231H00000X , with the licence number: AY1758 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QD0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QH0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QH0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0850X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QV0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 291900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 292200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 117295300 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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