NPI age
5 years
Enumerated 2021-04-09
● Active Type 2 · Organization
Ketamine Infusions Of Idaho
Ketamine Infusions Of Idaho 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
Stubbs
Owner
Last NPPES update
2021-04-09
Source: monthly bulk 2026-05
How this organization compares
Across 4 active clinic/center providers in Idaho.
NPI age
5 years
≈ at median (4 yr)
Practice locations
1
0 secondary on file
Subspecialties
0
NPI lifetime · 2021 → 2026
2021-04Enumerated in NPPES
2021
2026
Where they practice
Primary practice location
1582 Elk Creek Dr
Idaho Falls, ID 834048322
Mailing address
Po Box 3646
Idaho Falls, ID 834033646
Authorized official
Christina Stubbs, CRNA
Owner
📞 2086078401
Individual providers at this organization
3 individual providers on file at this primary practice address.
- Craig Allred, AUD Audiologist NPI 1184076465
- Benjamin Leishman, D.O. Family Medicine NPI 1063862977
- Josh Sirucek, D.O. Family Medicine NPI 1487066643
Specialties
-
Clinic/Center PrimaryDefinition to come...
Practice context
Multi-provider organization. 3 individual providers on file at this primary address.
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.