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NPI Code Detail

MEDICARE: IGNITE MEDICAL RESORT EDMOND LLC

MEDICARE: IGNITE MEDICAL RESORT EDMOND 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
1314000000XSkilled Nursing Facility

General Provider Information

NPI Number : 1710845466
Entity Type Code : Organization
Provider Name (Legal Business Name) : IGNITE MEDICAL RESORT EDMOND LLC
Provider Business Mailing Address
First Line : 1550 N NORTHWEST HWY STE 430
Second Line :
City : PARK RIDGE
State : IL
Zip : 60068-1461
Country : US
Telephone Number : 847-453-4000
Fax Number : 847-453-4000
Provider Business Practice Location Address
First Line : 1400 E MEMORIAL RD
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73131-1240
Country : US
Telephone Number : 405-875-0040
Fax Number :
Authorized Official
Title or Position : CEO
Name : TIMOTHY FIELDS
Credential :
Telephone Number : 847-453-4000
Provider Enumeration Date : 01/12/2026
Last Update Date : 01/12/2026

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Directions to “IGNITE MEDICAL RESORT EDMOND LLC ” Practice Location

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