MEDICARE: ITOX, LLC

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	291U00000X	Clinical Medical Laboratory	45D2082145	TX

General Provider Information

NPI Number	:	1790172310
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ITOX, LLC

Provider Business Mailing Address
First Line	:	330 W 47TH ST
Second Line	:	SUITE 250
City	:	KANSAS CITY
State	:	MO
Zip	:	64112-1659
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	525 ROUND ROCK WEST DR
Second Line	:	SUITE B200
City	:	ROUND ROCK
State	:	TX
Zip	:	78681-5020
Country	:	US
Telephone Number	:	888-802-5227
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	MICHAEL ENGLISH
Credential	:
Telephone Number	:	719-440-4717

Provider Enumeration Date	:	04/21/2015
Last Update Date	:	04/21/2015

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