Provider Demographics
NPI:1013950401
Name:BON-BONE MEDICAL IMAGING, INC.
Entity Type:Organization
Organization Name:BON-BONE MEDICAL IMAGING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-753-8557
Mailing Address - Street 1:7040 SEMINOLE PRATT WHITNEY RD
Mailing Address - Street 2:STE. 25-166
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-2468
Mailing Address - Country:US
Mailing Address - Phone:800-664-2663
Mailing Address - Fax:561-792-5199
Practice Address - Street 1:6499 38TH AVE N
Practice Address - Street 2:SUITE G2
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-1656
Practice Address - Country:US
Practice Address - Phone:727-341-2866
Practice Address - Fax:727-341-2876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL579259OtherAETNA
DC102686OtherAVMED
FL137014OtherPREFERRED CARE
FL2243437OtherAETNA
FL2243421OtherAETNA
DC2592718OtherGHI
FLV1836OtherBC/BS
FLV1267OtherBC/BS
FL7723768OtherAETNA
FLV1173OtherBC/BS
FLV1761OtherBC/BS
FL2243431OtherAETNA
FLE2011GMedicare ID - Type UnspecifiedSTP OFFICE
FL2243421OtherAETNA
FL7723768OtherAETNA
FL137014OtherPREFERRED CARE
FLE2011HMedicare ID - Type UnspecifiedDELRAY OFFICE