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General NPI Number Information
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NPI Number | 1295257988
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Entity Type | Organization
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Legal Business Name | KETAMINE HEALTH & WELLNESS CENTER OF TEXAS
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Dates
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Enumeration Date | 07/13/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 5944 W PARKER RD STE 400
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City | PLANO
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State | TX
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Zip | 75093-6443
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Country | US
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Telephone | 972-980-0500
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Fax | 972-980-0503
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Provider Business Mailing Address
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Address Line | 5944 W PARKER RD STE 400
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City | PLANO
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State | TX
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Zip | 75093-6443
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Country | US
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Telephone | 972-980-0500
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Fax | 972-980-0503
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | MRS. LESLIE K HILL
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Credential |
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Telephone | 972-980-0500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | L4969
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License Number State | TX
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