=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619817665
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRIGHTWAY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/30/2026
-----------------------------------------------------
Last Update Date | 03/30/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4050 REUNION CREEK PKWY
-----------------------------------------------------
City | APEX
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27539-9209
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-405-0700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4050 REUNION CREEK PKWY
-----------------------------------------------------
City | APEX
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27539-9209
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JALEN CONRAD MARTIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 786-504-0708
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------