10D2189514 CLIA NUMBER - KETAMINE HEALTH CENTERS OF WEST PALM BEACH LLC

Laboratory Demographics

CLIA Number: 10D2189514

Facility Name: KETAMINE HEALTH CENTERS OF WEST PALM BEACH LLC

Facility Address:
1411 N FLAGLER DR STE 9300B
WEST PALM BEACH, FL
ZIP 33401
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Facility Phone Number: 305 494-4170

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1073179396

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	10D2189514
LAB Type	Physician Office
Facility Name	KETAMINE HEALTH CENTERS OF WEST PALM BEACH LLC
Street	1411 N FLAGLER DR STE 9300B
City	WEST PALM BEACH
State	FL
ZIP	33401
Phone	305 494-4170
CertificateType	4
CertificateEffectiveDate	7/31/2022
CertificateExpirationDate	7/30/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024