Provider Demographics
NPI:1861654774
Name:BONHAM EMERGENCY MEDICINE LLC
Entity Type:Organization
Organization Name:BONHAM EMERGENCY MEDICINE LLC
Other - Org Name:GEMS EXPRESS CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RUBY
Authorized Official - Middle Name:F
Authorized Official - Last Name:YATES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-277-5974
Mailing Address - Street 1:76 CARLYLE PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62221-6677
Mailing Address - Country:US
Mailing Address - Phone:618-416-6560
Mailing Address - Fax:618-416-6561
Practice Address - Street 1:76 CARLYLE PLAZA DR
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62221-6677
Practice Address - Country:US
Practice Address - Phone:618-416-6560
Practice Address - Fax:618-416-6561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-01
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty