| Brainwire Llc | |
|
128 Keeneland Ln Lafayette LA 70503-6213 | |
| (337) 739-7037 | |
| Not Available |
| Full Name | Brainwire Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 128 Keeneland Ln, Lafayette, Louisiana |
| Authorized Official Name and Position | Adam Foreman (OWNER) |
| Authorized Official Contact | 3377397037 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Brainwire Llc 2851 Johnston St Pmb 512 Lafayette LA 70503-3243 Ph: () - | Brainwire Llc 128 Keeneland Ln Lafayette LA 70503-6213 Ph: (337) 739-7037 |
| NPI Number | 1548826803 |
|---|---|
| Provider Enumeration Date | 05/13/2019 |
| Last Update Date | 03/30/2022 |
| Certification Date | 03/24/2022 |
| Medicare PECOS PAC ID | 4486987591 |
|---|---|
| Medicare Enrollment ID | O20190604003330 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548826803 | NPI | - | NPPES |
| 1013132323 | Other | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
| Provider Name | Adam Neil Foreman |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1013132323 PECOS PAC ID: 0749446573 Enrollment ID: I20120724000353 |
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