Provider Demographics
NPI:1093751687
Name:MAX W KOCH
Entity Type:Organization
Organization Name:MAX W KOCH
Other - Org Name:MED LINK METRO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MAX
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:KOCH
Authorized Official - Suffix:III
Authorized Official - Credentials:CPED CFO
Authorized Official - Phone:817-909-6293
Mailing Address - Street 1:603 BISCAYNE DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-3235
Mailing Address - Country:US
Mailing Address - Phone:817-453-2800
Mailing Address - Fax:210-568-2682
Practice Address - Street 1:400 INDUSTRIAL BLVD
Practice Address - Street 2:STE 108
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-2202
Practice Address - Country:US
Practice Address - Phone:817-453-2800
Practice Address - Fax:210-568-2682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0055752332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies