Provider Demographics
NPI:1104968064
Name:TOIC, LLC
Entity type:Organization
Organization Name:TOIC, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:417-626-0072
Mailing Address - Street 1:1905 W 32ND ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-1529
Mailing Address - Country:US
Mailing Address - Phone:417-626-0072
Mailing Address - Fax:417-626-0919
Practice Address - Street 1:1905 W 32ND ST
Practice Address - Street 2:SUITE 106
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1529
Practice Address - Country:US
Practice Address - Phone:417-626-0072
Practice Address - Fax:417-626-0919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO716169800Medicaid
MO186482OtherBLUE CROSS
OK200039560BMedicaid
KS200278080AMedicaid
KS200278080AMedicaid