Provider Demographics
NPI:1134863822
Name:SAN ANTONIO KETAMINE SPECIALISTS PLLC
Entity type:Organization
Organization Name:SAN ANTONIO KETAMINE SPECIALISTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/CO-FOUNDER
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 1:1919 OAKWELL FARMS PKWY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78218
Mailing Address - Country:US
Mailing Address - Phone:210-960-6998
Mailing Address - Fax:210-960-6998
Practice Address - Street 1:1919 OAKWELL FARMS PKWY
Practice Address - Street 2:SUITE 110
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78218
Practice Address - Country:US
Practice Address - Phone:210-960-6998
Practice Address - Fax:210-960-6998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-27
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy