Provider Demographics
NPI:1659313112
Name:BONRO MEDICAL INC
Entity Type:Organization
Organization Name:BONRO MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:ROESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-210-4747
Mailing Address - Street 1:PO BOX 1880
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-1880
Mailing Address - Country:US
Mailing Address - Phone:706-210-4747
Mailing Address - Fax:706-210-4740
Practice Address - Street 1:4490 WASHINGTON RD
Practice Address - Street 2:BUILDING 100 SUITE 16
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3800
Practice Address - Country:US
Practice Address - Phone:706-210-4747
Practice Address - Fax:706-210-4740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA4850150001Medicare NSC