# IGNITE MEDICAL RESORT OKC, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1942801899
- **Authorized official:** TIMOTHY FIELDS (CEO)
- **Authorized official phone:** (847) 453-4000

## Contact information

- **Practice address:** 6312 N PORTLAND AVE, OKLAHOMA CITY, OK 73112-1463
- **Practice address phone:** (405) 946-6932
- **Mailing address:** 1550 N NORTHWEST HWY STE 430, PARK RIDGE, IL 60068-1461

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR0400X | Rehabilitation Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 11/06/2020
- **Last updated:** 11/06/2020