Provider Demographics
NPI:1801321278
Name:KOETTER, CHRISTOPHER
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:KOETTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1716 E SCOTT AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-8018
Mailing Address - Country:US
Mailing Address - Phone:940-322-0900
Mailing Address - Fax:940-322-0902
Practice Address - Street 1:1716 E SCOTT AVE
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-8018
Practice Address - Country:US
Practice Address - Phone:940-322-0900
Practice Address - Fax:940-322-0902
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-24
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No171WV0202XOther Service ProvidersContractorVehicle Modifications
No347C00000XTransportation ServicesPrivate Vehicle