Provider Demographics
NPI:1063643690
Name:BONNER PARTNERS IN CARE CLINIC
Entity Type:Organization
Organization Name:BONNER PARTNERS IN CARE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:PERUSSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-255-9099
Mailing Address - Street 1:1020 MICHIGAN ST
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-1788
Mailing Address - Country:US
Mailing Address - Phone:208-255-9099
Mailing Address - Fax:208-263-6963
Practice Address - Street 1:1020 MICHIGAN ST
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1788
Practice Address - Country:US
Practice Address - Phone:208-255-9099
Practice Address - Fax:208-263-6963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-30
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health