Healthcare Provider Details

I. General information

NPI: 1184026098
Provider Name (Legal Business Name): BRAINCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2014
Last Update Date: 05/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 N STADIUM BLVD STE 249
COLUMBIA MO
65203-1493
US

IV. Provider business mailing address

2670 FIREWHEEL DR STE B
FLOWER MOUND TX
75028-4601
US

V. Phone/Fax

Practice location:
  • Phone: 866-848-2522
  • Fax: 877-290-1544
Mailing address:
  • Phone: 866-848-2522
  • Fax: 972-692-8389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: JANICE SHOCK
Title or Position: SR DIRECTOR OF OPERATIONS
Credential:
Phone: 866-848-2522