Healthcare Provider Details

I. General information

NPI: 1043716426
Provider Name (Legal Business Name): SARAH ANN-LOUISE KOCH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2018
Last Update Date: 04/20/2025
Certification Date: 04/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W SPRUCE ST STE J
MISSOULA MT
59802-4047
US

IV. Provider business mailing address

PO BOX 31001-4110
PASADENA CA
91110-4110
US

V. Phone/Fax

Practice location:
  • Phone: 406-327-3350
  • Fax: 406-327-3355
Mailing address:
  • Phone: 406-327-3350
  • Fax: 406-327-3355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberML60865844.
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMED-PHYS-LIC-145219
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: