Provider Demographics
NPI:1407109812
Name:BOND COMMUNITY HEALTH CENTER
Entity Type:Organization
Organization Name:BOND COMMUNITY HEALTH CENTER
Other - Org Name:BOND SPECIALTY AND WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:GRAYSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-576-4073
Mailing Address - Street 1:1720 SOUTH GADSDEN ST
Mailing Address - Street 2:BOND COMMUNITY HEALTH CENTER
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-5506
Mailing Address - Country:US
Mailing Address - Phone:850-576-4073
Mailing Address - Fax:850-577-0675
Practice Address - Street 1:1549 SOUTH MONROE STREET
Practice Address - Street 2:BOND SPECIALITY AND WELLNESS
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301
Practice Address - Country:US
Practice Address - Phone:850-576-4073
Practice Address - Fax:850-576-0151
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOND COMMUNITY HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-23
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME76689207QA0505X
FLME80809207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty