Provider Demographics
NPI:1336838861
Name:RENEW HEALTH KETAMINE AND IV INFUSION THERAPY PLLC.
Entity Type:Organization
Organization Name:RENEW HEALTH KETAMINE AND IV INFUSION THERAPY PLLC.
Other - Org Name:RENEW HEALTH KETAMINE AND IV INFUSION THERAPY PLLC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SORIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNTEANU
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:337-508-9135
Mailing Address - Street 1:333 E BETHANY DR STE J100
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-3827
Mailing Address - Country:US
Mailing Address - Phone:337-508-9135
Mailing Address - Fax:
Practice Address - Street 1:333 E BETHANY DR STE J100
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-3827
Practice Address - Country:US
Practice Address - Phone:337-508-9135
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-02
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain