Provider Demographics
NPI:1629318415
Name:BONETT MEDICAL CENTER CORP
Entity Type:Organization
Organization Name:BONETT MEDICAL CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESDIENT
Authorized Official - Prefix:
Authorized Official - First Name:JADAY
Authorized Official - Middle Name:
Authorized Official - Last Name:SIGLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-481-2200
Mailing Address - Street 1:2675 WINKLER AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:239-481-2200
Mailing Address - Fax:239-481-2209
Practice Address - Street 1:2675 WINKLER AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-9342
Practice Address - Country:US
Practice Address - Phone:239-481-2200
Practice Address - Fax:239-481-2209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-15
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center