Provider Demographics
NPI:1518235563
Name:BRIGHT FUTURE PRIMARY CARE, INC.
Entity Type:Organization
Organization Name:BRIGHT FUTURE PRIMARY CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMAD
Authorized Official - Middle Name:HAKAM
Authorized Official - Last Name:ALNAHHAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-248-7778
Mailing Address - Street 1:PO BOX 2898
Mailing Address - Street 2:
Mailing Address - City:MIDDLESBORO
Mailing Address - State:KY
Mailing Address - Zip Code:40965-4898
Mailing Address - Country:US
Mailing Address - Phone:606-248-7778
Mailing Address - Fax:606-248-7787
Practice Address - Street 1:3602 WEST CUMBERLAND AVE.,
Practice Address - Street 2:STE. B-102
Practice Address - City:MIDDLESBORO
Practice Address - State:KY
Practice Address - Zip Code:40965
Practice Address - Country:US
Practice Address - Phone:606-248-7778
Practice Address - Fax:606-248-7787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-06
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY29890207Q00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100194870Medicaid