Baltimore Ketamine Clinic

LBN: Baltimore Ketamine Clinic
Baltimore Ketamine Clinic is an health care organization with primary practice located at 909 Ridgebrook Rd Ste 202 , Sparks MD 21152-9476. The organization recently has only one registered license in Ambulatory Health Care Facilities / Infusion Therapy, which is considered as the primary health care specialty. Baltimore Ketamine Clinic can be contacted via phone (410) 870-5482, or through Mitic, Ivana via phone (410) 870-5482.

Contact Information

Primary practice address
909 Ridgebrook Rd Ste 202 Sparks MD 21152-9476
Phone: (410) 870-5482
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Mitic, Ivana Certified Registered Nurse Anesthetist (CRNA)
Phone: (410) 870-5482

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Infusion Therapy 261QI0500X

Profile Details

NPI number 1508580275
LBN Legal business name Baltimore Ketamine Clinic
DBA Doing business as
Authorized official Mitic, Ivana Certified Registered Nurse Anesthetist (CRNA)
Entity Organization
Organization subpart 1 No
Enumeration date Sep 27th, 2022
Last updated Sep 27th, 2022 - about 4 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1508580275 NPPES
Maryland MEDICAID 209047300

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