Provider Demographics
NPI:1760025001
Name:BRAIN & PAIN CARE, LLC
Entity Type:Organization
Organization Name:BRAIN & PAIN CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAI
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNJAMPALLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-469-8517
Mailing Address - Street 1:8020 CAPTAIN DILLON CT
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71115-4606
Mailing Address - Country:US
Mailing Address - Phone:318-469-8517
Mailing Address - Fax:
Practice Address - Street 1:7600 FERN AVE STE 700B
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5673
Practice Address - Country:US
Practice Address - Phone:318-616-6000
Practice Address - Fax:318-616-6616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-18
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty