Provider Demographics
NPI:1770843906
Name:KOCH AUDIOLOGY, LLC
Entity Type:Organization
Organization Name:KOCH AUDIOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:STOUT
Authorized Official - Last Name:KOCH
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:317-464-9067
Mailing Address - Street 1:915 N WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-2505
Mailing Address - Country:US
Mailing Address - Phone:765-664-3470
Mailing Address - Fax:
Practice Address - Street 1:915 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-2505
Practice Address - Country:US
Practice Address - Phone:765-664-3470
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23002390A261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech