Provider Demographics
NPI:1629439195
Name:BOND CLINIC PA
Entity Type:Organization
Organization Name:BOND CLINIC PA
Other - Org Name:BOND & STEELE CLINIC PA
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:MOERSCHBACHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-293-1191
Mailing Address - Street 1:500 E CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-3053
Mailing Address - Country:US
Mailing Address - Phone:863-293-1191
Mailing Address - Fax:
Practice Address - Street 1:3000 WOODMONT AVE
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33884-3800
Practice Address - Country:US
Practice Address - Phone:863-293-1191
Practice Address - Fax:863-293-8035
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOND CLINIC PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-03-11
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL606419332B00000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Yes332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL99287Medicare PIN