DR. STANLEY W KOCH (NPI# 1467436436) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1467436436 |
| Entity Type | Individual |
| Full Name | DR. STANLEY W KOCH |
| Credential | MD |
| Practice Address |
411 Maxine Dr Morton IL 61550-2495 |
| Practice Telephone | 3092632411 |
| Practice Fax Number | 3092632208 |
| Mailing Telephone | 3092632411 |
| Mailing Fax Number | 3092632208 |
| Enumeration Date | 2005-12-02 |
| Last Update Date | 2010-08-23 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 036060959 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 371398455 | 05 | |
| IL | TAX ID# | 371398455 | 01 |
| Street Address |
411 MAXINE DR |
| City | MORTON |
| State | IL |
| Zip Code | 61550-2495 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205327616 | Anna Stiker | Physical Therapist | 411 Maxine Dr, Morton, IL 61550 | 2018-05-21 |
| 1992294003 | Lori Meints Gudat | Nurse Practitioner | 411 Maxine Dr, Morton, IL 61550-2495 | 2018-05-03 |
| 1972993814 | Restore Medical LLC | General Practice | 411 Maxine Dr, Morton, IL 61550-2495 | 2015-01-30 |
| 1538588298 | Jennifer Smidt | Nurse Practitioner | 411 Maxine Dr, Morton, IL 61550-2495 | 2014-04-09 |
| 1275724866 | Kimberly Yvette Ford | Family Medicine | 411 Maxine Dr, Morton, IL 61550-2495 | 2007-08-07 |
| 1376665125 | Koch Family Medicine Sc | Family Medicine | 411 Maxine Dr, Morton, IL 61550-2495 | 2007-04-04 |
| 1770539611 | Angela J Gilles | Nurse Practitioner | 411 Maxine Dr, Morton, IL 61550-2495 | 2006-05-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497398648 | Osf Multi-specialty Group | Non-Pharmacy Dispensing Site | 853 W Jackson Plaza, Morton, IL 61550 | 2019-10-21 |
| 1760924732 | The Center for Youth and Family Solutions | Residential Treatment Facility, Emotionally Disturbed Children | 260 E. Queenwood Rd., Cyfs Educational Building, Morton, IL 61550 | 2016-11-08 |
| 1770983181 | Jennifer Vissering | Nurse Practitioner | 435 Maxine Drive Suite #4, Morton, IL 61550 | 2014-09-04 |
| 1316387236 | Saint Johns Hospital | Rehabilitation Hospital | 141 E Maywood Street, Morton, IL 61550 | 2013-06-25 |
| 1801145610 | Nancy J. Anderson | Counselor | 42 Jasper Drive, Morton, IL 61550 | 2012-09-07 |
| 1689894834 | Kevin Littlefield | Dentist | 320 E Jackson, Morton, IL 61550 | 2007-04-30 |
| 1215081765 | Krueger & Associates LLC | Dentist | 213 S Clifton Street, Morton, IL 61550 | 2007-01-22 |
| 1073686218 | Darin Scott Hoffmire | Social Worker | 2401 South Fourth Street, Morton, IL 61550 | 2006-11-16 |
| 1629161856 | William Edwards | Pediatrics | 435 Maxine Drive, Suites 3 & 4, Morton, IL 61550 | 2006-10-02 |
| 1396844932 | G Gene Sidler | Internal Medicine | 619 Jackson St, Morton, IL 61550 | 2006-09-21 |
| Find all providers in zip 61550 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| 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. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669802948 | Lawrence Joseph Mellon | Family Medicine | 708 N. Morton Ave., Morton, PA 19070 | 2013-11-22 |
| 1407942592 | Merrell N Cooper | Family Medicine | 531 Adams Street, Morton, WA 98356-0018 | 2006-10-05 |
| 1518971977 | Ronald Hake | Family Medicine | 1909 N Morton Ave, Morton, IL 61550-1426 | 2006-07-28 |
| 1063453744 | Timothy F Jenkins | Family Medicine | 1803 Franklin Ave, Morton, PA 19070-1713 | 2006-06-10 |
| 1134116247 | Stanford Alan Shor | Family Medicine | 61 S Morton Ave, Suite 6, Morton, PA 19070-1740 | 2005-10-04 |
| 1619376720 | Visiting Physicians of Peoria Inc | Family Medicine | 612 W Jackson St, Morton, IL 61550-1536 | 2014-08-14 |
| 1629200753 | Catherine Beratio | Family Medicine | 435 Maxine Dr, Morton, IL 61550-2498 | 2009-08-24 |
| 1043445869 | Christopher Reavis Johnson | Family Medicine | 435 Maxine Dr, Morton, IL 61550-2498 | 2009-05-22 |
| 1396908257 | Gregory B Rogers | Family Medicine | 201 E Grant Ave, Morton, TX 79346-3444 | 2008-07-09 |
| 1447424791 | Jessica A. Tonozzi-kinzinger | Family Medicine | 435 Maxine Dr, Morton, IL 61550-2498 | 2008-04-17 |
| Find all providers in MORTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.