Individual ProviderMark KochFamily MedicineAllopathic & Osteopathic PhysiciansPractice Address1500 S Main St, Dept Of Family Medicine, Fort Worth, TX 76104-4917(817) 927-1200(817) 852-8440PECOS EnrollmentBased on the most recent information from CMS, provider Mark Koch is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1174512651Provider TypeIndividualFull NameKoch, MarkTitleDr.CredentialM.D.GenderMaleSole ProprietorNoEnumeration Date10/18/2005Last Updated6/3/2016Contact InformationPractice LocationPractice Address1500 S Main St, Dept Of Family Medicine, Fort Worth, TX 76104-4917Phone(817) 927-1200FaxUnlisted FaxMailing LocationMailing AddressPO Box 911294, Dallas, TX 75391-1294Phone(817) 852-8440FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode207Q00000XPrimaryDescriptionFamily MedicineAllopathic & Osteopathic PhysiciansLicenseJ4274Texas