Provider Demographics
NPI:1669162251
Name:LANCASTER KETAMINE INSTITUTE
Entity type:Organization
Organization Name:LANCASTER KETAMINE INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DO
Authorized Official - Prefix:
Authorized Official - First Name:SETH
Authorized Official - Middle Name:
Authorized Official - Last Name:GUNDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-553-0530
Mailing Address - Street 1:1689 CROWN AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-6314
Mailing Address - Country:US
Mailing Address - Phone:717-553-0530
Mailing Address - Fax:
Practice Address - Street 1:1689 CROWN AVE STE 2
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-6314
Practice Address - Country:US
Practice Address - Phone:717-553-0530
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy