Provider Demographics
NPI:1366120420
Name:KETAKLARITY
Entity type:Organization
Organization Name:KETAKLARITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:SHEFFLER
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA, APRN
Authorized Official - Phone:765-720-9025
Mailing Address - Street 1:833 INDIANAPOLIS RD STE B
Mailing Address - Street 2:
Mailing Address - City:GREENCASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:46135-1591
Mailing Address - Country:US
Mailing Address - Phone:765-630-8315
Mailing Address - Fax:
Practice Address - Street 1:833 INDIANAPOLIS RD STE B
Practice Address - Street 2:
Practice Address - City:GREENCASTLE
Practice Address - State:IN
Practice Address - Zip Code:46135-1591
Practice Address - Country:US
Practice Address - Phone:765-630-8315
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy