Sunrise Ketamine Clinic LLC

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

Legal business name

SUNRISE KETAMINE CLINIC LLC

Practice address

3555 Potomac Way Ste B
Idaho Falls, ID 83404-4985

Phone

(208) 524-9080

Fax

(208) 529-3786

NPI assigned

Oct 6, 2021

Organization subpart

No

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

Authorized official

Name

Bryan Todd Merkley, CRNA

Title

Owner

Phone

(208) 520-0527

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1633478400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633478400000",
    "number": "1205598398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3555 POTOMAC WAY STE B",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834044985",
            "telephone_number": "208-524-9080",
            "fax_number": "208-529-3786"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3555 POTOMAC WAY STE B",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834044985",
            "telephone_number": "208-524-9080",
            "fax_number": "208-529-3786"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUNRISE KETAMINE CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-06",
        "last_updated": "2021-10-06",
        "certification_date": "2021-10-06",
        "status": "A",
        "authorized_official_last_name": "MERKLEY",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_middle_name": "TODD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-520-0527",
        "authorized_official_credential": "CRNA"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Certified Registered Nurse Anesthetist in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Certified Registered Nurse Anesthetist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2021; 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.