OrganizationIris Ketamine & Infusions, LlcNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address9025 Coldwater Rd Ste 200, Fort Wayne, IN 46825-2097(866) 218-5620PECOS EnrollmentBased on the most recent information from CMS, provider Iris Ketamine & Infusions, Llc does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1598533986Provider TypeOrganizationFull NameIris Ketamine & Infusions, LlcSubpartNoEnumeration Date12/14/2023Last Updated12/14/2023Contact InformationPractice LocationPractice Address9025 Coldwater Rd Ste 200, Fort Wayne, IN 46825-2097Phone(866) 218-5620Fax(260) 888-2322Mailing LocationMailing Address9025 Coldwater Rd Ste 200, Fort Wayne, IN 46825-2097Phone(866) 218-5620Fax(260) 888-2322Authorized OfficialNameGoddard, Sean (Owner)Phone(866) 218-5620Provider TaxonomiesCodeDescriptionLicenseCode363L00000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicenseUnlisted Issuer