Provider Demographics
NPI:1316761968
Name:MCKOY, BOBBY L JR
Entity type:Individual
Prefix:
First Name:BOBBY
Middle Name:L
Last Name:MCKOY
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4525 CHANTILLY LN
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-2103
Mailing Address - Country:US
Mailing Address - Phone:336-201-2450
Mailing Address - Fax:
Practice Address - Street 1:4525 CHANTILLY LN
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-2103
Practice Address - Country:US
Practice Address - Phone:336-201-2450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)