KOCH FAMILY MEDICINE SC NPI 1376665125

NPI Information

  • NPI: 1376665125
  • Provider Name: KOCH FAMILY MEDICINE SC
  • Classification: Family Medicine - 207Q00000X
  • Entity Type: Organization
  • CLIA Number: 14D0677046
  • Address: 411 MAXINE DR
    MORTON, IL
    ZIP 61550
  • Phone: (309) 263-2411

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NPI Details

KOCH FAMILY MEDICINE SC is a family medicine in Morton, IL. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. KOCH FAMILY MEDICINE SC NPI is 1376665125. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

411 MAXINE DR
MORTON, IL
ZIP 61550-495
Phone: (309) 263-2411

The provider's authorized official is Stanley Koch .
The authorized official title is Physician and has the following contact phone number (309) 263-2411.

The CLIA number assigned to this NPI record is 14D0677046 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/4/2007 and was last updated on 10/20/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily MedicineYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1211327MEDICARE ID-TYPE UNSPECIFIEDILLINOISGROUP MC NUMBER
21467436436OTHERILLINOISINDIVIDUAL NPI NUMBER
3036060959MEDICAIDILLINOIS
4C41321MEDICARE UPINILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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