MEDICARE: IASPIRE 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
1	251B00000X	Case Management Agency
2	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114265691
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IASPIRE LLC

Provider Business Mailing Address
First Line	:	3721 STATON DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73111-5051
Country	:	US
Telephone Number	:	405-243-0020
Fax Number	:	405-652-0305

Provider Business Practice Location Address
First Line	:	3721 STATON DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73111-5051
Country	:	US
Telephone Number	:	405-243-0020
Fax Number	:	405-652-0305

Authorized Official
Title or Position	:	FOUNDER
Name	:	MR. JONAH MICHAEL JOHNSON
Credential	:
Telephone Number	:	405-243-0020

Provider Enumeration Date	:	01/18/2013
Last Update Date	:	03/18/2017

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Directions to “IASPIRE LLC ” Practice Location

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