| Koch Family Medicine Sc | |
|
411 Maxine Dr Morton IL 61550-2495 | |
| (309) 263-2411 | |
| Not Available |
| Full Name | Koch Family Medicine Sc |
|---|---|
| Speciality | Family Medicine |
| Location | 411 Maxine Dr, Morton, Illinois |
| Authorized Official Name and Position | Stanley Koch (PHYSICIAN) |
| Authorized Official Contact | 3092632411 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Koch Family Medicine Sc 411 Maxine Dr Morton IL 61550-2495 Ph: () - | Koch Family Medicine Sc 411 Maxine Dr Morton IL 61550-2495 Ph: (309) 263-2411 |
| NPI Number | 1376665125 |
|---|---|
| Provider Enumeration Date | 04/04/2007 |
| Last Update Date | 10/20/2010 |
| Medicare PECOS PAC ID | 1153378229 |
|---|---|
| Medicare Enrollment ID | O20050401000043 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376665125 | NPI | - | NPPES |
| 036060959 | Medicaid | IL | |
| 1467436436 | Other | IL | INDIVIDUAL NPI NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Angela J Gilles |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770539611 PECOS PAC ID: 2062477060 Enrollment ID: I20041201000140 |
| Provider Name | Stanley W Koch |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1467436436 PECOS PAC ID: 3779530845 Enrollment ID: I20050404000301 |
| Provider Name | Jonathan L Acklie |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1568437747 PECOS PAC ID: 9436180304 Enrollment ID: I20050830001028 |
| Provider Name | Brian J Staniszewski |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1558501106 PECOS PAC ID: 3971650367 Enrollment ID: I20090422000522 |
| Provider Name | Kimberly Y Ford |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1275724866 PECOS PAC ID: 8527194315 Enrollment ID: I20100331000695 |
| Provider Name | Andrew Aberle |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1447650403 PECOS PAC ID: 2264654409 Enrollment ID: I20141104000706 |
| Provider Name | Rose M Hoerr |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1699214338 PECOS PAC ID: 3072898360 Enrollment ID: I20170329001429 |
| Provider Name | Mary E Gerig |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1487772448 PECOS PAC ID: 5092068429 Enrollment ID: I20181031002342 |
| Provider Name | Shelby L Fehr |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184190613 PECOS PAC ID: 0244577005 Enrollment ID: I20190201000170 |
| Provider Name | Matthew A Kresnicka |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1134690522 PECOS PAC ID: 7911247846 Enrollment ID: I20190312003369 |
| Provider Name | Mary K Imig |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1912492448 PECOS PAC ID: 4486055944 Enrollment ID: I20210622002752 |
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