Provider Demographics
NPI:1093483893
Name:AUSTIN KETAMINE SPECIALISTS PLLC
Entity Type:Organization
Organization Name:AUSTIN KETAMINE SPECIALISTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:303-818-8137
Mailing Address - Street 1:320 W WILLIAM CANNON DR STE B
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-5691
Mailing Address - Country:US
Mailing Address - Phone:512-400-4311
Mailing Address - Fax:512-400-4311
Practice Address - Street 1:320 W WILLIAM CANNON DR STE B
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-5691
Practice Address - Country:US
Practice Address - Phone:512-400-4311
Practice Address - Fax:512-400-4311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-06
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy