Provider Demographics
NPI:1699972935
Name:BRIGHT MCCONNELL III MD LLC
Entity type:Organization
Organization Name:BRIGHT MCCONNELL III MD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIGHT
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCONNELL
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:843-284-5200
Mailing Address - Street 1:900 ISLAND PARK DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29492-7559
Mailing Address - Country:US
Mailing Address - Phone:843-284-5200
Mailing Address - Fax:843-284-5201
Practice Address - Street 1:900 ISLAND PARK DR
Practice Address - Street 2:SUITE 105
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29492-7559
Practice Address - Country:US
Practice Address - Phone:843-284-5200
Practice Address - Fax:843-284-5201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC6325330001Medicare NSC
SC8454Medicare PIN