MEDICARE: BRIGHT DIALYSIS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316179062
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIGHT DIALYSIS LLC

Provider Business Mailing Address
First Line	:	5200 VIRGINIA WAY
Second Line	:	L&C DEPT
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-7569
Country	:	US
Telephone Number	:	615-320-4214
Fax Number	:	877-735-8016

Provider Business Practice Location Address
First Line	:	2000 HARTMAN RD
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34947-4412
Country	:	US
Telephone Number	:	772-467-1117
Fax Number	:	772-595-9340

Authorized Official
Title or Position	:	MANAGER
Name	:	SUE E ROTTURA
Credential	:
Telephone Number	:	561-613-8830

Provider Enumeration Date	:	08/13/2009
Last Update Date	:	01/06/2016

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Directions to “BRIGHT DIALYSIS LLC ” Practice Location

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