Provider Demographics
NPI:1396826194
Name:BONHAM INTERNAL MEDICINE SERVICES, P.A.
Entity Type:Organization
Organization Name:BONHAM INTERNAL MEDICINE SERVICES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-361-0661
Mailing Address - Street 1:509 N CENTER ST
Mailing Address - Street 2:
Mailing Address - City:BONHAM
Mailing Address - State:TX
Mailing Address - Zip Code:75418-3705
Mailing Address - Country:US
Mailing Address - Phone:903-640-8300
Mailing Address - Fax:903-361-0714
Practice Address - Street 1:509 N CENTER ST
Practice Address - Street 2:
Practice Address - City:BONHAM
Practice Address - State:TX
Practice Address - Zip Code:75418-3705
Practice Address - Country:US
Practice Address - Phone:903-640-8300
Practice Address - Fax:903-361-0714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00363WMedicare ID - Type Unspecified