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General NPI Number Information
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NPI Number | 1649948449
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Entity Type | Organization
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Legal Business Name | HOUSTON KETAMINE SPECIALISTS PLLC
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Dates
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Enumeration Date | 09/06/2021
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Last Update Date | 09/06/2021
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Provider Practice Location Address
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Address Line | 2510 S LOOP 336 W STE 115
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City | CONROE
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State | TX
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Zip | 77304-3737
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Country | US
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Telephone | 936-362-3319
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Fax | 936-362-3319
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Provider Business Mailing Address
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Address Line | 409 W JOHANNA ST
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City | AUSTIN
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State | TX
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Zip | 78704-4235
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Country | US
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Telephone | 303-818-8137
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Fax | 936-362-3319
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. PAUL FOSTER
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Credential | DO
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Telephone | 303-818-8137
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number |
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License Number State |
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