Provider Demographics
NPI:1013932094
Name:KOCH, AMEE J (PA-C)
Entity type:Individual
Prefix:
First Name:AMEE
Middle Name:J
Last Name:KOCH
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 N IOWA ST
Mailing Address - Street 2:
Mailing Address - City:GUNNISON
Mailing Address - State:CO
Mailing Address - Zip Code:81230-2229
Mailing Address - Country:US
Mailing Address - Phone:970-641-1456
Mailing Address - Fax:
Practice Address - Street 1:2 EMBARCADERO CTR LBBY
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94111-3823
Practice Address - Country:US
Practice Address - Phone:888-663-6331
Practice Address - Fax:415-252-7176
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004376207Q00000X
ORPA01352363A00000X
CA52312363A00000X
COPA.0006681363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500606249Medicaid
ORP78840Medicare UPIN
WAGAB34505Medicare UPIN
OR500606249Medicaid