Provider Demographics
NPI:1801435789
Name:MILITARY MATTERS KETAMINE INFUSIONS OF COLORADO
Entity type:Organization
Organization Name:MILITARY MATTERS KETAMINE INFUSIONS OF COLORADO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXEC. VP OF ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAINER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-675-0058
Mailing Address - Street 1:949 E FILLMORE ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-6315
Mailing Address - Country:US
Mailing Address - Phone:719-399-0390
Mailing Address - Fax:719-399-0390
Practice Address - Street 1:530 COMMUNICATION CIR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80905-1744
Practice Address - Country:US
Practice Address - Phone:225-776-2253
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-24
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy