Provider Demographics
NPI:1265209134
Name:BRIGHTSTAR MEDICAL SUPPLY LLC
Entity type:Organization
Organization Name:BRIGHTSTAR MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:YONAS
Authorized Official - Middle Name:
Authorized Official - Last Name:BEREKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-643-4188
Mailing Address - Street 1:333 HAWAII AVE NE STE 5
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-4966
Mailing Address - Country:US
Mailing Address - Phone:202-643-4188
Mailing Address - Fax:
Practice Address - Street 1:333 HAWAII AVE NE STE 5
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-4966
Practice Address - Country:US
Practice Address - Phone:323-244-5504
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies