| Ketamine West Llc | |
|
602 26 1/2 Rd Grand Junction CO 81506-1905 | |
| (970) 427-4000 | |
| Not Available |
| Full Name | Ketamine West Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 602 26 1/2 Rd, Grand Junction, Colorado |
| Authorized Official Name and Position | Stryder River Reilly (OWNER/OPERATOR) |
| Authorized Official Contact | 9706441279 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ketamine West Llc 602 26 1/2 Rd Grand Junction CO 81506-1905 Ph: () - | Ketamine West Llc 602 26 1/2 Rd Grand Junction CO 81506-1905 Ph: (970) 427-4000 |
| NPI Number | 1477287290 |
|---|---|
| Provider Enumeration Date | 07/16/2022 |
| Last Update Date | 12/20/2022 |
| Certification Date | 12/20/2022 |
| Medicare PECOS PAC ID | 1951785690 |
|---|---|
| Medicare Enrollment ID | O20220830003148 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477287290 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Stryder River Reilly |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861780199 PECOS PAC ID: 0143561258 Enrollment ID: I20190417001845 |
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