Provider Demographics
NPI:1790476737
Name:BRAIN GROUP
Entity Type:Organization
Organization Name:BRAIN GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCNEIL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:601-324-3109
Mailing Address - Street 1:608 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39648-4025
Mailing Address - Country:US
Mailing Address - Phone:601-324-3109
Mailing Address - Fax:601-324-3105
Practice Address - Street 1:608 DELAWARE AVENUE, MCCOMB, MISSISSIPPI, UNITED STATES
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648
Practice Address - Country:US
Practice Address - Phone:601-324-3109
Practice Address - Fax:601-324-3105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-19
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center