MEDICARE: CARRICK BRAIN CENTERS

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	261QM1300X	Multi-Specialty Clinic/Center	680840000	TX

General Provider Information

NPI Number	:	1982138830
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARRICK BRAIN CENTERS

Provider Business Mailing Address
First Line	:	105 DECKER CT
Second Line	:	SUITE 105
City	:	IRVING
State	:	TX
Zip	:	75062-2767
Country	:	US
Telephone Number	:	214-771-8885
Fax Number	:

Provider Business Practice Location Address
First Line	:	105 DECKER CT
Second Line	:	SUITE 105
City	:	IRVING
State	:	TX
Zip	:	75062-2767
Country	:	US
Telephone Number	:	214-771-8885
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	JIMMY MATTHEWS
Credential	:
Telephone Number	:	214-504-1821

Provider Enumeration Date	:	04/18/2017
Last Update Date	:	04/18/2017

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Directions to “CARRICK BRAIN CENTERS ” Practice Location

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