| Complete Ketamine Solutions Hollywood Llc | |
|
2450 Hollywood Blvd Ste 701 Hollywood FL 33020-6628 | |
| (954) 367-5316 | |
| (954) 367-5374 |
| Full Name | Complete Ketamine Solutions Hollywood Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2450 Hollywood Blvd Ste 701, Hollywood, Florida |
| Authorized Official Name and Position | Clint Fletcher (OWNER) |
| Authorized Official Contact | 6153003096 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Complete Ketamine Solutions Hollywood Llc 2450 Hollywood Blvd Ste 701 Hollywood FL 33020-6628 Ph: (954) 367-5316 | Complete Ketamine Solutions Hollywood Llc 2450 Hollywood Blvd Ste 701 Hollywood FL 33020-6628 Ph: (954) 367-5316 |
| NPI Number | 1295498830 |
|---|---|
| Provider Enumeration Date | 10/20/2021 |
| Last Update Date | 10/20/2021 |
| Medicare PECOS PAC ID | 6204227515 |
|---|---|
| Medicare Enrollment ID | O20211221001945 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295498830 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Clinton Fletcher |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1215991658 PECOS PAC ID: 9638071459 Enrollment ID: I20211208001772 |
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