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General NPI Number Information
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NPI Number | 1801435789
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Entity Type | Organization
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Legal Business Name | MILITARY MATTERS KETAMINE INFUSIONS OF COLORADO
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Dates
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Enumeration Date | 12/24/2019
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Last Update Date | 02/21/2020
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Provider Practice Location Address
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Address Line | 530 COMMUNICATION CIR
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City | COLORADO SPRINGS
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State | CO
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Zip | 80905-1744
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Country | US
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Telephone | 225-776-2253
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Fax |
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Provider Business Mailing Address
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Address Line | 949 E FILLMORE ST
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City | COLORADO SPRINGS
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State | CO
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Zip | 80907-6315
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Country | US
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Telephone | 719-399-0390
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Fax | 719-399-0390
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Authorized Official
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Title or Position | EXEC. VP OF ADMINISTRATION
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Name | GREG TRAINER
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Credential |
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Telephone | 719-675-0058
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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