Provider Demographics
NPI:1457371262
Name:TIMOTHY J. BRIGHT, D.O., INC.
Entity Type:Organization
Organization Name:TIMOTHY J. BRIGHT, D.O., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:BRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:740-967-5931
Mailing Address - Street 1:340 W COSHOCTON ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:43031-1113
Mailing Address - Country:US
Mailing Address - Phone:740-967-5931
Mailing Address - Fax:740-967-8192
Practice Address - Street 1:340 W COSHOCTON ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:OH
Practice Address - Zip Code:43031-1113
Practice Address - Country:US
Practice Address - Phone:740-967-5931
Practice Address - Fax:740-967-8192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-003490B207Q00000X
OH34-003688V207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0607909Medicaid
OH0518818Medicaid
OHD89768Medicare UPIN
OHBR0532341Medicare ID - Type Unspecified
OH0607909Medicaid
OHVA0573151Medicare ID - Type Unspecified