Provider Demographics
NPI:1437576832
Name:BONOM ANESTHESIA
Entity Type:Organization
Organization Name:BONOM ANESTHESIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVAN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:BONOM
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:865-594-2047
Mailing Address - Street 1:PO BOX 16068
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27261-6068
Mailing Address - Country:US
Mailing Address - Phone:888-447-7220
Mailing Address - Fax:
Practice Address - Street 1:1720 WEST AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-4066
Practice Address - Country:US
Practice Address - Phone:931-787-1940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-24
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty