Healthcare Provider Details

I. General information

NPI: 1245039734
Provider Name (Legal Business Name): SAMUEL WESLEY BRIGHT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2025
Last Update Date: 03/10/2025
Certification Date: 03/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

498 OLDE MILL DR
WESTERVILLE OH
43082-1028
US

IV. Provider business mailing address

9261 HEDGE ROW CT
CENTERVILLE OH
45458-9674
US

V. Phone/Fax

Practice location:
  • Phone: 614-607-2356
  • Fax:
Mailing address:
  • Phone: 937-350-7125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: