Provider Demographics
NPI:1801930045
Name:JAEG BRIGHT MEDICAL SERVICES,INC.
Entity type:Organization
Organization Name:JAEG BRIGHT MEDICAL SERVICES,INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR / DON
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMERIA
Authorized Official - Middle Name:LASHONDA
Authorized Official - Last Name:KELLY-PENA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:713-779-7042
Mailing Address - Street 1:6420 HILLCROFT ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-3190
Mailing Address - Country:US
Mailing Address - Phone:713-779-7042
Mailing Address - Fax:713-779-7093
Practice Address - Street 1:6420 HILLCROFT ST
Practice Address - Street 2:SUITE 210
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-3190
Practice Address - Country:US
Practice Address - Phone:713-779-7042
Practice Address - Fax:713-779-7093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX014266251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX159877301Medicaid
TX679229Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER