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General NPI Number Information
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NPI Number | 1154906733
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Entity Type | Organization
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Legal Business Name | IGNITE MEDICAL RESORT BARTLESVILLE, LLC
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Dates
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Enumeration Date | 03/15/2021
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Last Update Date | 03/15/2021
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Provider Practice Location Address
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Address Line | 6006 SE ADAMS BLVD
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City | BARTLESVILLE
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State | OK
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Zip | 74006-8960
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Country | US
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Telephone | 918-331-0550
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Fax |
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Provider Business Mailing Address
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Address Line | 1550 N NORTHWEST HWY STE 430
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City | PARK RIDGE
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State | IL
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Zip | 60068-1461
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Country | US
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Telephone | 833-944-6483
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | TIM FIELDS
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Credential |
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Telephone | 847-453-4000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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