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General NPI Number Information
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NPI Number | 1902332448
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Entity Type | Organization
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Legal Business Name | JOPLIN PAIN CARE GROUP LLC
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Dates
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Enumeration Date | 05/03/2017
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Last Update Date | 05/03/2017
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Provider Practice Location Address
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Address Line | 2705 S RANGE LINE RD SUITE C
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City | JOPLIN
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State | MO
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Zip | 64804-3254
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Country | US
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Telephone | 417-622-5736
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Fax | 417-622-5736
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Provider Business Mailing Address
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Address Line | 4510 W CENTRAL AVE SUITE B
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City | WICHITA
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State | KS
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Zip | 67212-2203
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | TODD H ECK
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Credential |
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Telephone | 417-622-5736
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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