Provider Demographics
NPI:1639280183
Name:BRIGHT FUTURE PEDIATRICS, P.S.C.
Entity type:Organization
Organization Name:BRIGHT FUTURE PEDIATRICS, P.S.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:POON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-371-7400
Mailing Address - Street 1:4885 HOUSTON RD STE 101
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-4894
Mailing Address - Country:US
Mailing Address - Phone:859-371-7400
Mailing Address - Fax:859-371-8472
Practice Address - Street 1:4885 HOUSTON RD STE 101
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-4894
Practice Address - Country:US
Practice Address - Phone:859-371-7400
Practice Address - Fax:859-371-8472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100221020Medicaid