Healthcare Provider Details

I. General information

NPI: 1518235563
Provider Name (Legal Business Name): BRIGHT FUTURE PRIMARY CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2011
Last Update Date: 04/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3602 WEST CUMBERLAND AVE., STE. B-102
MIDDLESBORO KY
40965
US

IV. Provider business mailing address

PO BOX 2898
MIDDLESBORO KY
40965-4898
US

V. Phone/Fax

Practice location:
  • Phone: 606-248-7778
  • Fax: 606-248-7787
Mailing address:
  • Phone: 606-248-7778
  • Fax: 606-248-7787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number29890
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number29890
License Number StateKY

VIII. Authorized Official

Name: MOHAMAD HAKAM ALNAHHAS
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 606-248-7778