Healthcare Provider Details

I. General information

NPI: 1508227091
Provider Name (Legal Business Name): BOND CLINIC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2016
Last Update Date: 08/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 SUN N LAKE BLVD
SEBRING FL
33872-2167
US

IV. Provider business mailing address

500 E CENTRAL AVE
WINTER HAVEN FL
33880-3053
US

V. Phone/Fax

Practice location:
  • Phone: 863-385-5506
  • Fax: 863-385-4560
Mailing address:
  • Phone: 863-293-1191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number606883
License Number StateFL

VIII. Authorized Official

Name: MR. JASON MOERSCHBACHER
Title or Position: CFO
Credential:
Phone: 863-293-1191