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General NPI Number Information
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NPI Number | 1902603277
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Entity Type | Organization
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Legal Business Name | KETAMINE CLINIC OF SPOKANE LLC
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Dates
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Enumeration Date | 02/25/2025
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Last Update Date | 02/25/2025
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Provider Practice Location Address
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Address Line | 3707 S GRAND BLVD STE 101D
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City | SPOKANE
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State | WA
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Zip | 99203-2762
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Country | US
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Telephone | 509-934-7177
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1385
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City | IDAHO FALLS
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State | ID
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Zip | 83403-1385
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Country | US
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Telephone | 800-338-5378
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOSHUA SPARTZ
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Credential | CRNA
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Telephone | 509-847-9835
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number |
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License Number State |
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