Summit Ketamine, PC

Primary specialty

Infusion Therapy Clinic/CenterTaxonomy code 261QI0500X

Legal business name

SUMMIT KETAMINE, PC

Practice address

19284 Cottonwood Dr Ste 200
Parker, CO 80138-3881

Phone

(719) 641-7614

NPI assigned

Mar 18, 2019

Organization subpart

No

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

Authorized official

Name

Dr. Sarah Lynn Coakley, DO

Title

President

Phone

(719) 641-7614

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Summit Ketamine Innovations Doing business as

Electronic endpoints 1

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

{
    "created_epoch": "1552867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1552867200000",
    "number": "1912466004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2077 S CLARKSON ST",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802104105",
            "telephone_number": "719-641-7614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19284 COTTONWOOD DR STE 200",
            "city": "PARKER",
            "state": "CO",
            "postal_code": "801383881",
            "telephone_number": "719-641-7614"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMIT KETAMINE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-18",
        "last_updated": "2019-03-18",
        "status": "A",
        "authorized_official_last_name": "COAKLEY",
        "authorized_official_first_name": "SARAH",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "719-641-7614",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "261QI0500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Infusion Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PERSONAL NPI",
            "identifier": "1578616413",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "info@summitketamine.com",
            "affiliation": "N",
            "address_1": "19284 Cottonwood Dr Ste 200",
            "city": "Parker",
            "state": "CO",
            "country_code": "US",
            "postal_code": "801383881",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Summit Ketamine Innovations",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Tanja Sukovic, D.C.
• Karen Elizabeth Suleks Freimanis, PHYSICAL THERAPIST
• Mariana Christine Sullivan Martinez
• Erin Jane Sullivan, OTR/L
• Janna Summerlin, LCSW
• Summit Kids Physical Therapy, LLC
• Sun Clinic, Inc.
• John H Sun, MD
• Sunny Speech Solutions, LLC
• Sunshine Enterprises Limited

• Infusion Therapy Clinic/Center in Parker, CO
• Providers in Parker, CO by specialty
• Infusion Therapy Clinic/Center in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2019; 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.