Provider Demographics
NPI:1053611178
Name:KOCH, BARBARA
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:KOCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10860 GULFDALE ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-3607
Mailing Address - Country:US
Mailing Address - Phone:210-315-8242
Mailing Address - Fax:210-348-8533
Practice Address - Street 1:10860 GULFDALE ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-3607
Practice Address - Country:US
Practice Address - Phone:210-315-8242
Practice Address - Fax:210-348-8533
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-22
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No171W00000XOther Service ProvidersContractor
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
962653023OtherCCR-DUNS