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? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 332B00000X | Suppliers | Durable Medical Equipment & Medical Supplies |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
GA | 4850150001 | Medicare NSC |