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NPI Code Detail

MEDICARE: BRAINCARE, LLC

MEDICARE: BRAINCARE, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1293D00000XPhysiological Laboratory

General Provider Information

NPI Number : 1598209538
Entity Type Code : Organization
Provider Name (Legal Business Name) : BRAINCARE, LLC
Provider Business Mailing Address
First Line : 2670 FIREWHEEL DR
Second Line : STE B
City : FLOWER MOUND
State : TX
Zip : 75028-4601
Country : US
Telephone Number : 866-848-2522
Fax Number : 877-290-1544
Provider Business Practice Location Address
First Line : 2355 HIGHWAY 36 W
Second Line : STE 400
City : ROSEVILLE
State : MN
Zip : 55113-3902
Country : US
Telephone Number : 866-848-2522
Fax Number : 877-290-1544
Authorized Official
Title or Position : SR DIRECTOR OF OPERATIONS
Name : JANICE SHOCK
Credential :
Telephone Number : 214-532-3757
Provider Enumeration Date : 12/09/2016
Last Update Date : 12/09/2016

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Directions to “BRAINCARE, LLC ” Practice Location

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