MEDICARE: MR. THOMAS MARTIN BONDS I

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	311ZA0620X	Adult Care Home Facility		FL

General Provider Information

NPI Number	:	1417753898
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS MARTIN BONDS I

Provider Business Mailing Address
First Line	:	PO BOX 3731
Second Line	:
City	:	LAKE WALES
State	:	FL
Zip	:	33859-3731
Country	:	US
Telephone Number	:	863-412-9702
Fax Number	:

Provider Business Practice Location Address
First Line	:	2202 BOUYER ST
Second Line	:
City	:	LAKE WALES
State	:	FL
Zip	:	33898-8552
Country	:	US
Telephone Number	:	863-412-9702
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/24/2025
Last Update Date	:	02/24/2025

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