NPI age
3 years
Enumerated 2023-05-02
● Active Type 2 · Organization
Prestige Ketamine Pc
Prestige Ketamine Pc is 1 of 4 clinic/center organizations in Idaho.
Primary specialty
Clinic/Center
Practice locations
1
0 secondary on file
Status
Active
No deactivations on record
Authorized official
Hansen
Ceo
Last NPPES update
2023-05-02
Source: monthly bulk 2026-05
How this organization compares
Across 4 active clinic/center providers in Idaho.
NPI age
3 years
≈ at median (4 yr)
Practice locations
1
0 secondary on file
Subspecialties
0
NPI lifetime · 2023 → 2026
2023-05Enumerated in NPPES
2023
2026
Where they practice
Primary practice location
3749 E 343 N
Rigby, ID 834425326
Mailing address
3749 E 343 N
Rigby, ID 834425326
Authorized official
Levi Hansen
Ceo
📞 2087059800
Specialties
-
Clinic/Center PrimaryDefinition to come...
Practice context
Single-site organization. Only one practice location on file.
Provyx · Custom healthcare lists
Need all 4 Clinic/Center providers in Idaho?
Get the full list as a CSV with verified work emails, direct phones, and LinkedIn URLs.
Request a quote →How to verify this organization
- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
- Verify the organization is in good standing.Cross-check with the state's business registration and any applicable licensing boards.
- Confirm payer enrollment if billing.NPI presence does not guarantee active enrollment with Medicare, Medicaid, or commercial payers.