Provider Demographics
NPI:1366604431
Name:MEDCOY INC
Entity type:Organization
Organization Name:MEDCOY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:F
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:352-236-2525
Mailing Address - Street 1:11512 E COUNTY ROAD 316
Mailing Address - Street 2:PO BOX 2220
Mailing Address - City:FORT MC COY
Mailing Address - State:FL
Mailing Address - Zip Code:32134-2220
Mailing Address - Country:US
Mailing Address - Phone:352-236-2525
Mailing Address - Fax:325-236-8610
Practice Address - Street 1:11512 E COUNTY ROAD 316
Practice Address - Street 2:
Practice Address - City:FT MCCOY
Practice Address - State:FL
Practice Address - Zip Code:32134-2220
Practice Address - Country:US
Practice Address - Phone:352-236-2525
Practice Address - Fax:352-236-8610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS2972207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL049466600Medicaid
FL049466600Medicaid
FL81723AMedicare PIN