MEDICARE: DR. LINDSEY RAE KOCH AUD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist	375A	SD

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00902392	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	375A	OTHER	SD	SD LICENSE

General Provider Information

NPI Number	:	1487964144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LINDSEY RAE KOCH AUD

Provider Business Mailing Address
First Line	:	5124 S WESTERN AVE
Second Line	:	SUITE 4
City	:	SIOUX FALLS
State	:	SD
Zip	:	57108-5047
Country	:	US
Telephone Number	:	605-275-5545
Fax Number	:	605-275-5546

Provider Business Practice Location Address
First Line	:	5124 S WESTERN AVE
Second Line	:	SUITE 4
City	:	SIOUX FALLS
State	:	SD
Zip	:	57108-5047
Country	:	US
Telephone Number	:	605-275-5545
Fax Number	:	605-275-5546

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/15/2010
Last Update Date	:	06/05/2012

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