Arizona Ketamine Specialists LLC

Primary specialty

Infusion Therapy Clinic/CenterTaxonomy code 261QI0500X

Legal business name

ARIZONA KETAMINE SPECIALISTS LLC

Practice address

18205 N 51St Ave Ste 105
Glendale, AZ 85308-1491

Phone

(623) 688-8531

Fax

(602) 277-8146

NPI assigned

Dec 11, 2020

Last updated

Dec 11, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

David Vanlirop, MD

Title

Manager

Phone

(480) 414-9986

Specialties & licenses 2

Addresses

Locations

Practitioners 4

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.

• Joseph Darrel Haggard, D.C.

  • Chiropractor
  • Glendale, AZ
  • NPI 1609817857
  NPD (past)
• Brandon Roderick Howell

  • Certified Registered Nurse Anesthetist
  • Phoenix, AZ
  • NPI 1902280068
  NPD (past)
• Thomas James Vernon, M.D.

  • Anesthesiology Physician
  • Phoenix, AZ
  • NPI 1891056362
  NPD (past)
• Anastasia A Ganesh, CRNA

  • Certified Registered Nurse Anesthetist
  • Madison Heights, MI
  • NPI 1811905490
  NPD (past)

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

{
    "created_epoch": "1607644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607644800000",
    "number": "1255937439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 39179",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850699179",
            "telephone_number": "602-395-0718",
            "fax_number": "602-277-8146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18205 N 51ST AVE STE 105",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853081491",
            "telephone_number": "623-688-8531",
            "fax_number": "602-277-8146"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ARIZONA KETAMINE SPECIALISTS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-11",
        "last_updated": "2020-12-11",
        "certification_date": "2020-12-11",
        "status": "A",
        "authorized_official_last_name": "VANLIROP",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "480-414-9986",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QI0500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Infusion Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Arizona Family Care PLLC
• Arizona Fitness Chiropractic LLC
• Arizona Gastroenterology and Liver Clinic,P.C.
• Arizona Hearcare Network, Inc
• Arizona Internal Medicine Specialists, PLC (Thunderbird Internal Medicine)
• Arizona Lighthouse Assisted Living LLC
• Arizona Maternity and Women's Clinic, Inc
• Arizona Medical Supply & Equipment
• Arizona Mental Health Institute, L.L.C.
• Arizona Multisports Physical Therapy LLC

• Infusion Therapy Clinic/Center in Glendale, AZ
• Providers in Glendale, AZ by specialty
• Infusion Therapy Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 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.