MEDICARE: SIDNEY ANN KOTHE MHS, PA-C

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	363A00000X	Physician Assistant	15-02571	KS
2	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1205597135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIDNEY ANN KOTHE MHS, PA-C

Provider Business Mailing Address
First Line	:	1805 1/2 E 17TH AVE
Second Line	:
City	:	HUTCHINSON
State	:	KS
Zip	:	67501-1102
Country	:	US
Telephone Number	:	620-615-7197
Fax Number	:

Provider Business Practice Location Address
First Line	:	1805 1/2 E 17TH AVE
Second Line	:
City	:	HUTCHINSON
State	:	KS
Zip	:	67501-1102
Country	:	US
Telephone Number	:	620-615-7197
Fax Number	:

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

Provider Enumeration Date	:	01/03/2022
Last Update Date	:	09/23/2024

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