Provider Demographics
NPI:1689157752
Name:BRAIN HEALTH DIAGNOSTICS LLC
Entity Type:Organization
Organization Name:BRAIN HEALTH DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:SIEFFERT
Authorized Official - Suffix:
Authorized Official - Credentials:DC, MHSM
Authorized Official - Phone:480-205-9447
Mailing Address - Street 1:425 E 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-4905
Mailing Address - Country:US
Mailing Address - Phone:480-331-4540
Mailing Address - Fax:480-696-5816
Practice Address - Street 1:425 E 11TH AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-4905
Practice Address - Country:US
Practice Address - Phone:480-331-4540
Practice Address - Fax:480-696-5816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile