Provider Demographics
NPI:1720649064
Name:METRO MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:METRO MEDICAL GROUP LLC
Other - Org Name:KETAMINE TREATMENT CENTERS OF AMERICA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:M
Authorized Official - Last Name:RHODES
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:480-676-3555
Mailing Address - Street 1:3201 W PEORIA AVE STE A105
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-4609
Mailing Address - Country:US
Mailing Address - Phone:480-676-3555
Mailing Address - Fax:480-999-4481
Practice Address - Street 1:3201 W PEORIA AVE STE A105
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-4609
Practice Address - Country:US
Practice Address - Phone:480-676-3555
Practice Address - Fax:480-999-4481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-26
Last Update Date:2019-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)Group - Multi-Specialty
No163WI0500XNursing Service ProvidersRegistered NurseInfusion TherapyGroup - Multi-Specialty
No163WP0000XNursing Service ProvidersRegistered NursePain ManagementGroup - Multi-Specialty