Healthcare Provider Details

I. General information

NPI: 1710647326
Provider Name (Legal Business Name): IGNITE MEDICAL RESORT ROUND ROCK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2021
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16219 RANCH ROAD 620 N
AUSTIN TX
78717-5209
US

IV. Provider business mailing address

1550 N NORTHWEST HWY STE 430
PARK RIDGE IL
60068-1461
US

V. Phone/Fax

Practice location:
  • Phone: 512-520-1834
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY FIELDS
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 630-327-2951