Provider Demographics
NPI:1902332448
Name:JOPLIN PAIN CARE GROUP LLC
Entity Type:Organization
Organization Name:JOPLIN PAIN CARE GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:H
Authorized Official - Last Name:ECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-622-5736
Mailing Address - Street 1:4510 W CENTRAL AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-2203
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2705 S RANGE LINE RD
Practice Address - Street 2:SUITE C
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-3254
Practice Address - Country:US
Practice Address - Phone:417-622-5736
Practice Address - Fax:417-622-5736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-03
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty