Organization
VITASUITE IV & KETAMINE THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RUTH PETROS CRNA (PART OWNER)
(712) 775-2434
Entity
Organization
Contact information
Practice address
509 N ADAMS ST STE 2, CARROLL, IA 51401-2767
(712) 775-2434
(712) 775-2534
Mailing address
509 N ADAMS ST STE 2, CARROLL, IA 51401-2767
(712) 775-2434
(712) 775-2534
Taxonomy
Speciality
Code
Description
License number
State
261QI0500X
Infusion Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
03/02/2021
Last updated
10/21/2021
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