Provider Demographics
NPI:1003130840
Name:BOND COMMUNITY HEALTH CENTER INC
Entity Type:Organization
Organization Name:BOND COMMUNITY HEALTH CENTER INC
Other - Org Name:YOURX PATIENT PHARMACY AT BONDCHC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODMAAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-576-4073
Mailing Address - Street 1:1720 S GADSDEN ST
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-5506
Mailing Address - Country:US
Mailing Address - Phone:850-521-5112
Mailing Address - Fax:850-521-5108
Practice Address - Street 1:1720 S GADSDEN ST
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-5506
Practice Address - Country:US
Practice Address - Phone:850-521-5112
Practice Address - Fax:850-521-5108
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOND COMMUNITY HEALTH CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-23
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH245283336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL98705AMedicare PIN