NPIMap

Organization Active NPI

Ketamine Infusions of Idaho

  • Infusion Therapy Clinic/Center
  • Idaho Falls, ID
National Provider Identifier
1730769142
Registry record updated Apr 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infusion Therapy Clinic/CenterTaxonomy code 261QI0500X
Legal business name
KETAMINE INFUSIONS OF IDAHO
Practice address
1582 Elk Creek Dr
Idaho Falls, ID 83404-8322
Phone
(208) 607-8401
NPI assigned
Apr 9, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2021

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

Authorized official

Name
Christina Stubbs, CRNANPI 1932471331
Title
Owner
Phone
(208) 607-8401

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Infusion Therapy Clinic/Center 261QI0500X Primary

Addresses

Primary practice location

1582 Elk Creek Dr
Idaho Falls, ID 83404-8322

Mailing address

PO Box 3646
Idaho Falls, ID 83403-3646
Phone (208) 607-8401

National Provider Directory

National Provider Directory

Locations

1532 Elk Creek Dr
Idaho Falls, ID 83404

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1617926400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1617926400000",
    "number": "1730769142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3646",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834033646",
            "telephone_number": "208-607-8401",
            "fax_number": "208-534-5838"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1582 ELK CREEK DR",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834048322",
            "telephone_number": "208-607-8401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KETAMINE INFUSIONS OF IDAHO",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-09",
        "last_updated": "2021-04-09",
        "certification_date": "2021-04-09",
        "status": "A",
        "authorized_official_last_name": "STUBBS",
        "authorized_official_first_name": "CHRISTINA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-607-8401",
        "authorized_official_credential": "CRNA"
    },
    "taxonomies": [
        {
            "code": "261QI0500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Infusion Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Idaho Falls, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 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.