NPIMap

Organization Active NPI

Ketamine Wellness Centers Jacksonville

Doing business as Ketamine Wellness Centers

  • Pain Medicine (Anesthesiology) Physician
  • Jacksonville, FL
National Provider Identifier
1063016988
Registry record updated Nov 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
Legal business name
KETAMINE WELLNESS CENTERS JACKSONVILLE
Doing business as
Ketamine Wellness Centers
Practice address
3753-2 Cardinal Point Dr
Jacksonville, FL 32257-5582
Phone
(855) 538-9355
Fax
(844) 538-9355
NPI assigned
Nov 23, 2020
Last updated
Nov 23, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
KETAMINE WELLNESS CENTERS ARIZONA LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 23, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Anita Jerger
Title
Executive Assistant
Phone
(855) 538-9355

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Anesthesiology) Physician 207LP2900X NU Primary

Addresses

Primary practice location

3753-2 Cardinal Point Dr
Jacksonville, FL 32257-5582

Mailing address

113 W Hoover Ave Ste 101
Mesa, AZ 85210-5214
Phone (855) 538-9355

Other names 1

  • Ketamine Wellness Centers Doing business as

National Provider Directory

National Provider Directory
Part of
Ketamine Wellness Centers Arizona LLC

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1606089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606089600000",
    "number": "1063016988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "113 W HOOVER AVE STE 101",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852105214",
            "telephone_number": "855-538-9355",
            "fax_number": "844-538-9355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3753-2 CARDINAL POINT DR",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322575582",
            "telephone_number": "855-538-9355",
            "fax_number": "844-538-9355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KETAMINE WELLNESS CENTERS JACKSONVILLE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KETAMINE WELLNESS CENTERS ARIZONA LLC",
        "enumeration_date": "2020-11-23",
        "last_updated": "2020-11-23",
        "certification_date": "2020-11-23",
        "status": "A",
        "authorized_official_last_name": "JERGER",
        "authorized_official_first_name": "ANITA",
        "authorized_official_title_or_position": "EXECUTIVE ASSISTANT",
        "authorized_official_telephone_number": "855-538-9355",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ketamine Wellness Centers",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.