Organization
IGNITE MEDICAL RESORT OKC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY FIELDS (CEO)
(847) 453-4000
Entity
Organization
Contact information
Practice address
6312 N PORTLAND AVE, OKLAHOMA CITY, OK 73112-1463
(405) 946-6932
Mailing address
1550 N NORTHWEST HWY STE 430, PARK RIDGE, IL 60068-1461
Taxonomy
Speciality
Code
Description
License number
State
261QR0400X
Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
11/06/2020
Last updated
11/06/2020
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