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KOCH FAMILY MEDICINE SC
NPI 1376665125
Family Medicine in Morton, IL

Active since April 04, 2007CLIA 14D0677046 · Waiver
411 MAXINE DR, MORTON, IL 61550(309) 263-2411 Get Directions Write a Review

NPPES record last updated: October 20, 2010. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Koch Family Medicine Sc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KOCH FAMILY MEDICINE SC (NPI 1376665125) is a healthcare organization registered as a family medicine in Morton, Illinois and active in the NPI registry since April 2007. The organization holds a CLIA Waiver certificate valid through August 31, 2026 and lists Stanley Koch, Physician, as its authorized official.

NPPES Registry Identity

NPI1376665125
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameKOCH FAMILY MEDICINE SC
Location Address411 MAXINE DRMorton, IL 61550-2495
Mailing Address411 Maxine DrMorton, IL 61550-2495
Phone(309) 263-2411
Organization SubpartNo
Authorized OfficialStanley KochPhysician · (309) 263-2411
Enumeration DateApril 4, 2007
Last NPPES UpdateOctober 20, 2010
✔ NPI 1376665125 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
411 MAXINE DR, Morton, IL 61550
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Other Identifiers 4

Medicare ID-Type Unspecified211327IL · Group Mc Number
Other1467436436IL · Individual Npi Number
Medicaid036060959IL
Medicare UPINC41321IL

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 14D0677046

Koch Family Medicine · Morton, IL
Active · expires Aug 31, 2026
CLIA Number14D0677046
Laboratory TypePhysician Office
Certificate Effective DateSeptember 1, 2024
Certificate Expiration DateAugust 31, 2026
Laboratory DirectorDr. Stanley W. Koch
Laboratory Phone(309) 263-2411
Laboratory LocationKoch Family Medicine411 Maxine Dr, Morton, IL 61550
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 6

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. KIMBERLY YVETTE FORD D.O.
Family Medicine
411 MAXINE DR
MORTON, IL 61550
Tazewell County (309) 263-2411
DR. STANLEY W KOCH MD
Family Medicine
411 MAXINE DR
MORTON, IL 61550
Tazewell County (309) 263-2411
JENNIFER SMIDT
Nurse Practitioner (Gerontology)
411 MAXINE DR
MORTON, IL 61550
Tazewell County (309) 263-2411
ANGELA J GILLES MSFNP
Nurse Practitioner (Family)
411 MAXINE DR
MORTON, IL 61550
Tazewell County (309) 263-2411
RESTORE MEDICAL LLC
General Practice
411 MAXINE DR
MORTON, IL 61550
Tazewell County (309) 291-0988
MRS. LORI MEINTS GUDAT NP
Nurse Practitioner (Family)
411 MAXINE DR
MORTON, IL 61550
Tazewell County (309) 266-9757

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Koch Family Medicine Sc's NPI number?

The NPI number for Koch Family Medicine Sc is 1376665125. It was assigned to this organization in the NPPES registry on April 4, 2007.

Where is Koch Family Medicine Sc located?

Koch Family Medicine Sc is located at 411 Maxine Dr, Morton, IL 61550. The listed phone number is (309) 263-2411.

What is Koch Family Medicine Sc's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Does Koch Family Medicine Sc hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 14D0677046) is associated with this NPI, valid through August 31, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Koch Family Medicine Sc was last updated on October 20, 2010. NPI Profile syncs with the weekly NPPES data releases published by CMS.