NPIMap

Organization Active NPI

Rebekah Koch, M.D., PLLC

Doing business as Tall Pines Family Clinic

  • Psychiatry Physician
  • Lufkin, TX
National Provider Identifier
1770849184
Registry record updated Apr 10, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
P1888 Issued in TX
Legal business name
REBEKAH KOCH, M.D., PLLC
Doing business as
Tall Pines Family Clinic
Practice address
1105 W Frank Ave
Suite 280
Lufkin, TX 75904-3303
Phone
(936) 639-4393
Fax
(936) 639-0877
NPI assigned
Apr 10, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Rebekah W Koch, M.D.NPI 1417119603
Title
President
Phone
(936) 639-4393

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X P1888 TX Primary

Addresses

Primary practice location

1105 W Frank Ave
Suite 280
Lufkin, TX 75904-3303

Mailing address

1105 W Frank Ave
Suite 280
Lufkin, TX 75904-3303
Phone (936) 639-4393

Other names 1

  • Tall Pines Family Clinic Doing business as

National Provider Directory

National Provider Directory

Locations

1105 W Frank Ave
Ste 280
Lufkin, TX 75904
Phone (936) 639-4393

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1334016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1334016000000",
    "number": "1770849184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1105 W FRANK AVE",
            "address_2": "SUITE 280",
            "city": "LUFKIN",
            "state": "TX",
            "postal_code": "759043303",
            "telephone_number": "936-639-4393",
            "fax_number": "936-639-0877"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1105 W FRANK AVE",
            "address_2": "SUITE 280",
            "city": "LUFKIN",
            "state": "TX",
            "postal_code": "759043303",
            "telephone_number": "936-639-4393",
            "fax_number": "936-639-0877"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REBEKAH KOCH, M.D., PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-10",
        "last_updated": "2012-04-10",
        "status": "A",
        "authorized_official_last_name": "KOCH",
        "authorized_official_first_name": "REBEKAH",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "936-639-4393",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "TX",
            "license": "P1888",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tall Pines Family Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lufkin, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.