Ageless Restoration LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

AGELESS RESTORATION LLC

Practice address

3351 W Rock Creek Rd Ste 100
Norman, OK 73072-2463

Phone

(405) 928-4229

Fax

(405) 561-4065

NPI assigned

Sep 7, 2022

Last updated

Sep 7, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Gordon Ronald Hart, PACNPI 1265862023

Title

Owner

Phone

(405) 928-4229

Specialties & licenses 1

Addresses

Electronic endpoints 1

Locations

Interoperability endpoints

• Direct secure messaging: contactus@balancehormonecenter.com

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Gordon Hart, PA-C

  • Physician Assistant
  • Norman, OK
  • NPI 1265862023
  NPD Authorized official
• Amanda Rasmussen, APRN, CNP

  • Family Nurse Practitioner
  • Norman, OK
  • NPI 1588168082
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1662508800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1662508800000",
    "number": "1689395782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 15782",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731555782",
            "telephone_number": "405-455-3964",
            "fax_number": "210-800-9921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3351 W ROCK CREEK RD STE 100",
            "city": "NORMAN",
            "state": "OK",
            "postal_code": "730722463",
            "telephone_number": "405-928-4229",
            "fax_number": "405-561-4065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AGELESS RESTORATION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-07",
        "last_updated": "2022-09-07",
        "certification_date": "2022-09-07",
        "status": "A",
        "authorized_official_last_name": "HART",
        "authorized_official_first_name": "GORDON",
        "authorized_official_middle_name": "RONALD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "405-928-4229",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PAC"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "contactus@balancehormonecenter.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "3351 W Rock Creek Rd Ste 100",
            "city": "Norman",
            "state": "OK",
            "country_code": "US",
            "postal_code": "730722463",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Primary Care Clinic/Center in Norman, OK
• Providers in Norman, OK by specialty
• Primary Care Clinic/Center in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.