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NPI Code Detail

MEDICARE: IGNITE MEDICAL RESORT OKC, LLC

MEDICARE: IGNITE MEDICAL RESORT OKC, 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
1261QR0400XRehabilitation Clinic/Center

General Provider Information

NPI Number : 1942801899
Entity Type Code : Organization
Provider Name (Legal Business Name) : IGNITE MEDICAL RESORT OKC, 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 :
Fax Number :
Provider Business Practice Location Address
First Line : 6312 N PORTLAND AVE
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73112-1463
Country : US
Telephone Number : 405-946-6932
Fax Number :
Authorized Official
Title or Position : CEO
Name : TIMOTHY FIELDS
Credential :
Telephone Number : 847-453-4000
Provider Enumeration Date : 11/06/2020
Last Update Date : 11/06/2020

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Directions to “IGNITE MEDICAL RESORT OKC, LLC ” Practice Location

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