Provider Demographics
NPI:1629620950
Name:BONNELL HEALTH AND WELLNESS
Entity Type:Organization
Organization Name:BONNELL HEALTH AND WELLNESS
Other - Org Name:BONNELL HEALTH AND WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DARCE
Authorized Official - Middle Name:
Authorized Official - Last Name:LATSIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-588-0880
Mailing Address - Street 1:560 S 300 E STE 275
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84111-3586
Mailing Address - Country:US
Mailing Address - Phone:801-441-1002
Mailing Address - Fax:
Practice Address - Street 1:19 BONNELL LANE
Practice Address - Street 2:SUITE A
Practice Address - City:CARTHAGE
Practice Address - State:TN
Practice Address - Zip Code:38030
Practice Address - Country:US
Practice Address - Phone:618-588-0880
Practice Address - Fax:615-588-0881
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FUTURA MEDICAL CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-16
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center