MEDICARE: BRAIN FOOD CLINIC

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
1	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1629742408
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRAIN FOOD CLINIC

Provider Business Mailing Address
First Line	:	P.O. BOX 10400
Second Line	:
City	:	JACKSON
State	:	WY
Zip	:	83002
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	680 S CACHE ST STE 10010400
Second Line	:
City	:	JACKSON
State	:	WY
Zip	:	83001-8694
Country	:	US
Telephone Number	:	212-518-6718
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CHRISTOPHER A RAMSEY
Credential	:	MD
Telephone Number	:	212-518-6718

Provider Enumeration Date	:	08/04/2021
Last Update Date	:	08/04/2021

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Directions to “BRAIN FOOD CLINIC ” Practice Location

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