Provider Demographics
NPI:1720175649
Name:BUNNELL MEDICAL CENTER INC
Entity Type:Organization
Organization Name:BUNNELL MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GEORGIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CANAKARIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-437-2481
Mailing Address - Street 1:PO BOX 727
Mailing Address - Street 2:
Mailing Address - City:BUNNELL
Mailing Address - State:FL
Mailing Address - Zip Code:32110-0727
Mailing Address - Country:US
Mailing Address - Phone:386-437-2481
Mailing Address - Fax:386-437-2024
Practice Address - Street 1:700 E. MOODY BLVD
Practice Address - Street 2:
Practice Address - City:BUNNELL
Practice Address - State:FL
Practice Address - Zip Code:32110
Practice Address - Country:US
Practice Address - Phone:386-437-2481
Practice Address - Fax:386-437-2404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4541207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty