Healthcare Provider Details

I. General information

NPI: 1497345029
Provider Name (Legal Business Name): BRIGHTWAY MOBILITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2021
Last Update Date: 01/18/2021
Certification Date: 01/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 S BLOUNT ST
RALEIGH NC
27603-2507
US

IV. Provider business mailing address

1525 S BLOUNT ST
RALEIGH NC
27603-2507
US

V. Phone/Fax

Practice location:
  • Phone: 919-800-9902
  • Fax: 888-643-2044
Mailing address:
  • Phone: 919-800-9902
  • Fax: 888-643-2044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MARK E PHIPPS
Title or Position: PRESIDENT
Credential:
Phone: 919-800-9902