Provider Demographics
NPI:1033964499
Name:BRADY MEDICAL GROUP PLLC
Entity Type:Organization
Organization Name:BRADY MEDICAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:NIKEYIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAXTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-409-4657
Mailing Address - Street 1:3800 GAYLORD PKWY STE 1190
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-9418
Mailing Address - Country:US
Mailing Address - Phone:844-409-4657
Mailing Address - Fax:
Practice Address - Street 1:1700 COIT RD STE 110
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-6138
Practice Address - Country:US
Practice Address - Phone:844-409-4657
Practice Address - Fax:214-614-4279
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRADY MEDICAL GROUP PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-04-19
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep MedicineGroup - Single Specialty
No261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic