Provider Demographics
NPI:1407345572
Name:COMPLETE BRAIN CENTER, LLC
Entity Type:Organization
Organization Name:COMPLETE BRAIN CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:MAX
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-510-7892
Mailing Address - Street 1:405 STATE HIGHWAY 121 BYP STE 150
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-4147
Mailing Address - Country:US
Mailing Address - Phone:833-272-4633
Mailing Address - Fax:
Practice Address - Street 1:405 STATE HIGHWAY 121 BYP STE 150
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-4147
Practice Address - Country:US
Practice Address - Phone:833-272-4633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-04
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty