Provider Demographics
NPI:1750569893
Name:NANCY RUDD-MCCOY MD PC
Entity type:Organization
Organization Name:NANCY RUDD-MCCOY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:RUDD-MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-289-0395
Mailing Address - Street 1:600 NW 11TH ST
Mailing Address - Street 2:SUITE E-19
Mailing Address - City:HERMISTON
Mailing Address - State:OR
Mailing Address - Zip Code:97838-8602
Mailing Address - Country:US
Mailing Address - Phone:541-289-0395
Mailing Address - Fax:541-289-0405
Practice Address - Street 1:600 NW 11TH ST
Practice Address - Street 2:SUITE E-19
Practice Address - City:HERMISTON
Practice Address - State:OR
Practice Address - Zip Code:97838-8602
Practice Address - Country:US
Practice Address - Phone:541-289-0395
Practice Address - Fax:541-289-0405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR287874Medicaid
ORC02547Medicare UPIN
ORR121039Medicare PIN