Provider Demographics
NPI:1629343025
Name:BRAINCARE, LLC
Entity Type:Organization
Organization Name:BRAINCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTES
Authorized Official - Suffix:
Authorized Official - Credentials:REEGT, RPSGT, NCST
Authorized Official - Phone:866-848-2522
Mailing Address - Street 1:2670 FIREWHEEL DR
Mailing Address - Street 2:STE B
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-4601
Mailing Address - Country:US
Mailing Address - Phone:866-848-2522
Mailing Address - Fax:
Practice Address - Street 1:7633 E 63RD PL
Practice Address - Street 2:STE 300, UNIT 309
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-1273
Practice Address - Country:US
Practice Address - Phone:866-848-2522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-19
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKOKB6108Medicare PIN