MEDICARE: BOND COMMUNITY HEALTH CENTER, INC.

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	207Q00000X	Family Medicine Physician
2	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1770084824
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOND COMMUNITY HEALTH CENTER, INC.

Provider Business Mailing Address
First Line	:	1720 S GADSDEN ST
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32301-5506
Country	:	US
Telephone Number	:	850-576-4073
Fax Number	:	850-577-0675

Provider Business Practice Location Address
First Line	:	2200 SOUTH MONROE
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32301
Country	:	US
Telephone Number	:	850-576-4073
Fax Number	:	850-577-0675

Authorized Official
Title or Position	:	BILLING SUPERVISOR
Name	:	MRS. DEIRDRE VICKERS
Credential	:	BS
Telephone Number	:	850-576-4073

Provider Enumeration Date	:	02/23/2018
Last Update Date	:	12/02/2025

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