Provider Demographics
NPI:1184385809
Name:KETAMINE WELLNESS CENTERS RENO LLC
Entity type:Organization
Organization Name:KETAMINE WELLNESS CENTERS RENO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-788-8539
Mailing Address - Street 1:1255 W BASELINE RD STE A-182
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-5820
Mailing Address - Country:US
Mailing Address - Phone:480-788-8539
Mailing Address - Fax:
Practice Address - Street 1:1895 PLUMAS ST STE 6
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-3384
Practice Address - Country:US
Practice Address - Phone:855-538-9355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KETAMINE WELLNESS CENTERS ARIZONA LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-01-05
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty