Join the Bright HealthCare Network

Please use the contact form below to let us know more about your primary practice location.

Group Legal Entity Name

Practice Website

Business Phone

Fax

Zip Code

County

City

Practice NPI (10 digits)

Tax ID (9 digits)

Preferred Contact First Name

Preferred Contact Last Name

Preferred Contact Email

Confirm Preferred Contact Email

Any additional questions or comments?

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