Basic Information
| Provider Information | |||||||||
| NPI: | 1134126717 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SOCH | ||||||||
| FirstName: | KATHLEEN | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 919 HIDDEN RDG | ||||||||
| Address2: | |||||||||
| City: | IRVING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750383813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4692822711 | ||||||||
| FaxNumber: | 4692822609 | ||||||||
| Practice Location | |||||||||
| Address1: | 2606 HOSPITAL BLVD STE B | ||||||||
| Address2: | |||||||||
| City: | CORPUS CHRISTI | ||||||||
| State: | TX | ||||||||
| PostalCode: | 784051804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3619024789 | ||||||||
| FaxNumber: | 3619024588 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2005 | ||||||||
| LastUpdateDate: | 04/08/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | B26552 | TX | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | G0145 | TX | N | Allopathic & Osteopathic Physicians | Family Medicine | 207QG0300X | B26552 | TX | N | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine | 207QG0300X | G0145 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | P02601817 | 01 | TX | MCRR | OTHER | 1L5842 | 01 | TX | MEDICARE | OTHER | 102018204 | 05 | TX | MEDICAID | 102018205 | 05 | TX | MEDICAID |