Healthcare Provider Details

I. General information

NPI: 1689492548
Provider Name (Legal Business Name): CARDIAC AND PULMONARY REHABILITATION CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2024
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 MEDICAL CENTER DRIVE
KINGFISHER OK
73750
US

IV. Provider business mailing address

PO BOX 28
KINGFISHER OK
73750-0028
US

V. Phone/Fax

Practice location:
  • Phone: 580-922-1107
  • Fax:
Mailing address:
  • Phone: 580-922-1107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. MELISSA C. JONES
Title or Position: MANAGER - CO-OWNER
Credential: MSN
Phone: 580-922-1107