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General NPI Number Information
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NPI Number | 1912466004
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Entity Type | Organization
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Legal Business Name | SUMMIT KETAMINE, PC
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Dates
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Enumeration Date | 03/18/2019
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Last Update Date | 03/18/2019
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Provider Practice Location Address
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Address Line | 19284 COTTONWOOD DR STE 200
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City | PARKER
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State | CO
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Zip | 80138-3881
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Country | US
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Telephone | 719-641-7614
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Fax |
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Provider Business Mailing Address
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Address Line | 2077 S CLARKSON ST
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City | DENVER
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State | CO
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Zip | 80210-4105
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Country | US
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Telephone | 719-641-7614
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SARAH LYNN COAKLEY
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Credential | DO
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Telephone | 719-641-7614
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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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