Provider Demographics
NPI:1871923599
Name:BRIGHT PROSTHETICS INC.
Entity type:Organization
Organization Name:BRIGHT PROSTHETICS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CP / LP
Authorized Official - Phone:216-906-6246
Mailing Address - Street 1:26401 EMERY RD SUITE 111
Mailing Address - Street 2:
Mailing Address - City:WARRENSVILLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44128-5970
Mailing Address - Country:US
Mailing Address - Phone:216-342-5516
Mailing Address - Fax:216-342-5519
Practice Address - Street 1:26401 EMERY RD SUITE 111
Practice Address - Street 2:
Practice Address - City:WARRENSVILLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44128-5970
Practice Address - Country:US
Practice Address - Phone:216-342-5516
Practice Address - Fax:216-342-5519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-15
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLP.238335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH6977350001Medicare NSC