MEDICARE: BRAINTECH 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
1	246ZE0500X	EEG Specialist/Technologist

General Provider Information

NPI Number	:	1982334827
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRAINTECH LLC

Provider Business Mailing Address
First Line	:	11901 N MACARTHUR BLVD STE C5
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73162-1852
Country	:	US
Telephone Number	:	405-286-1016
Fax Number	:	405-242-2016

Provider Business Practice Location Address
First Line	:	11901 N MACARTHUR BLVD STE E2
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73162-1856
Country	:	US
Telephone Number	:	405-286-1016
Fax Number	:	405-242-2016

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ZAK T THOMPSON
Credential	:
Telephone Number	:	405-286-1016

Provider Enumeration Date	:	06/14/2022
Last Update Date	:	09/17/2025

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