Provider Demographics
NPI:1295257988
Name:KETAMINE HEALTH & WELLNESS CENTER OF TEXAS
Entity type:Organization
Organization Name:KETAMINE HEALTH & WELLNESS CENTER OF TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-980-0500
Mailing Address - Street 1:5944 W PARKER RD STE 400
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-6443
Mailing Address - Country:US
Mailing Address - Phone:972-980-0500
Mailing Address - Fax:972-980-0503
Practice Address - Street 1:5944 W PARKER RD STE 400
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-6443
Practice Address - Country:US
Practice Address - Phone:972-980-0500
Practice Address - Fax:972-980-0503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4969207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty