Provider Demographics
NPI:1639309842
Name:BOND COMMUNITY HEALTH CENTER
Entity type:Organization
Organization Name:BOND COMMUNITY HEALTH CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:GRAYSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-576-4073
Mailing Address - Street 1:1720 SOUTH GADSDEN ST.
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301
Mailing Address - Country:US
Mailing Address - Phone:850-576-4073
Mailing Address - Fax:850-577-0675
Practice Address - Street 1:2729-8 MUNICIPAL WAY
Practice Address - Street 2:KAY FREEMAN HEALTH CENTER
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32304
Practice Address - Country:US
Practice Address - Phone:850-576-4073
Practice Address - Fax:850-576-0151
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOND COMMUNITY HEALTH CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-22
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80809207R00000X
FLME1013532084P0800X
FLOS8157208D00000X
FLARNP3353752363LA2200X
FLARNP1727122364SP0809X
FLME76689207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, AdultGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL060551401Medicaid
FL060551400OtherMEDICAID FFS
FL101909OtherMEDICARE FQHC
FL060551402Medicaid