| Revitalize Ketamine Clinic Llc | |
|
1800 S Milton Rd Ste 26 Flagstaff AZ 86001-6340 | |
| (928) 213-6931 | |
| Not Available |
| Full Name | Revitalize Ketamine Clinic Llc |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 1800 S Milton Rd Ste 26, Flagstaff, Arizona |
| Authorized Official Name and Position | Jill Michelle Dubravcic (OWNER/OPERATOR) |
| Authorized Official Contact | 9282136931 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Revitalize Ketamine Clinic Llc 1800 S Milton Rd Ste 26 Flagstaff AZ 86001-6340 Ph: () - | Revitalize Ketamine Clinic Llc 1800 S Milton Rd Ste 26 Flagstaff AZ 86001-6340 Ph: (928) 213-6931 |
| NPI Number | 1346911195 |
|---|---|
| Provider Enumeration Date | 09/22/2021 |
| Last Update Date | 09/22/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346911195 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
North Country Healthcare-ponderosa Hs Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2384 N Steves Blvd, Flagstaff, AZ 86004 Phone: 928-522-9410 Fax: 928-522-9411 | |
Aspen Family Medicine Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2912 N West St, Flagstaff, AZ 86004 Phone: 928-774-3627 Fax: 927-774-1400 | |
Ryan Internal Medicine Pc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 107 E Oak Ave, Suite 202, Flagstaff, AZ 86001 Phone: 928-773-2560 Fax: 928-913-8835 | |
Vasco Healthcare Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 930 N Switzer Canyon Dr Ste 201, Flagstaff, AZ 86001 Phone: 602-346-0204 | |
Native Americans For Community Action, Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1500 E Cedar Ave, Ste 26, Flagstaff, AZ 86004 Phone: 928-773-1245 Fax: 928-773-9429 | |
North Country Healthcare Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2920 N 4th St, Flagstaff, AZ 86004 Phone: 928-213-6121 Fax: 928-774-6687 | |
North Country Healthcare, Inc. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2920 N. 4th Street, Flagstaff, AZ 86004 Phone: 928-522-9400 Fax: 928-774-6687 |