Brilliant Medical Boutique, LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

BRILLIANT MEDICAL BOUTIQUE, LLC

Practice address

6800 Harris Pkwy Ste 300
Fort Worth, TX 76132-4262

Phone

(682) 312-9300

Fax

(682) 312-9133

NPI assigned

Feb 11, 2008

Last updated

Sep 8, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jamie B Mittendorf

Title

Owner

Phone

(817) 594-5868

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Brilliant Medical Boutique LLC

  • Durable Medical Equipment & Medical Supplies
  • Weatherford, TX
  • NPI 1497793830

  1254533656

  Same PAC ID

Tax ID family

Brilliant Medical Boutique LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Brilliant Medical Boutique LLC

  • Durable Medical Equipment & Medical Supplies
  • Weatherford, TX
  • NPI 1497793830
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1202688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1662595200000",
    "number": "1770751950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6800 HARRIS PKWY STE 300",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761324262",
            "telephone_number": "682-312-9300",
            "fax_number": "682-312-9133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6800 HARRIS PKWY STE 300",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761324262",
            "telephone_number": "682-312-9300",
            "fax_number": "682-312-9133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRILLIANT MEDICAL BOUTIQUE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-11",
        "last_updated": "2022-09-08",
        "certification_date": "2022-09-08",
        "status": "A",
        "authorized_official_last_name": "MITTENDORF",
        "authorized_official_first_name": "JAMIE",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "817-594-5868"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "TN",
            "license": "CFM01117",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brighter Days Living
• Brighter Future for Children and Families, PLLC
• Brighter Possibilities Family Counseling
• Brightstar Medical Supply
• Tierra N Brightwell
• Meredith Brim, MD
• Cheyenne Amaro Brinegar, LCDC-I
• Alice Brinkley
• Claudia Briones
• John G Briscoe, MD

• Durable Medical Equipment & Medical Supplies in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Durable Medical Equipment & Medical Supplies in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.