Provider Demographics
NPI:1255658423
Name:BRIGHT FUTURES PEDIATRICS SOUTH CAROLINA
Entity Type:Organization
Organization Name:BRIGHT FUTURES PEDIATRICS SOUTH CAROLINA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CMO
Authorized Official - Prefix:DR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:M
Authorized Official - Last Name:BARABELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-641-6967
Mailing Address - Street 1:78 BULL ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29401-1303
Mailing Address - Country:US
Mailing Address - Phone:845-641-6967
Mailing Address - Fax:
Practice Address - Street 1:78 BULL ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29401-1303
Practice Address - Country:US
Practice Address - Phone:845-641-6967
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-28
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC29943261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service