Provider Demographics
NPI:1689492548
Name:CARDIAC AND PULMONARY REHABILITATION CLINIC LLC
Entity type:Organization
Organization Name:CARDIAC AND PULMONARY REHABILITATION CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:C
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:BSN
Authorized Official - Phone:580-922-1107
Mailing Address - Street 1:PO BOX 374
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:OK
Mailing Address - Zip Code:73737-0374
Mailing Address - Country:US
Mailing Address - Phone:580-922-1107
Mailing Address - Fax:580-438-2298
Practice Address - Street 1:5962 N 2920 RD
Practice Address - Street 2:
Practice Address - City:HENNESSEY
Practice Address - State:OK
Practice Address - Zip Code:73742-7402
Practice Address - Country:US
Practice Address - Phone:580-922-1107
Practice Address - Fax:580-438-2298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-30
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2278P1005XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedPulmonary RehabilitationGroup - Single Specialty