MEDICARE: A BRIGHTER CHOICE

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	305R00000X	Preferred Provider Organization

General Provider Information

NPI Number	:	1558641472
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A BRIGHTER CHOICE

Provider Business Mailing Address
First Line	:	PO BOX 14167
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76094-1167
Country	:	US
Telephone Number	:	214-707-9387
Fax Number	:

Provider Business Practice Location Address
First Line	:	1309 PORTA ST APT 805
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76120-4109
Country	:	US
Telephone Number	:	214-707-9387
Fax Number	:

Authorized Official
Title or Position	:	PROGRAM MANAGER
Name	:	MS. EDWINA LEIGH SMITH
Credential	:
Telephone Number	:	682-472-4680

Provider Enumeration Date	:	08/23/2011
Last Update Date	:	08/23/2011

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Directions to “A BRIGHTER CHOICE ” Practice Location

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