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General NPI Number Information
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NPI Number | 1497271381
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Entity Type | Organization
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Legal Business Name | BRAIN ASSIST, 20
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Dates
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Enumeration Date | 08/22/2017
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Last Update Date | 08/22/2017
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Provider Practice Location Address
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Address Line | 2205 GRAYSTONE
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City | KELLER
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State | TX
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Zip | 76248-8362
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Country | US
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Telephone | 682-693-7774
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Fax |
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Provider Business Mailing Address
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Address Line | 2205 GRAYSTONE
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City | KELLER
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State | TX
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Zip | 76248-8362
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | THOMAS ELLIS
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Credential |
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Telephone | 682-693-7774
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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