Healthcare Provider Details

I. General information

NPI: 1649550047
Provider Name (Legal Business Name): BOND COMMUNITY HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2011
Last Update Date: 12/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1704 JOE LEWIS STREET
TALLAHASSEE FL
32304
US

IV. Provider business mailing address

1720 SOUTH GADSDEN ST.
TALLAHASSEE FL
32301
US

V. Phone/Fax

Practice location:
  • Phone: 850-576-4073
  • Fax: 850-577-0675
Mailing address:
  • Phone: 850-576-4073
  • Fax: 850-577-0675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN M GRAYSON
Title or Position: CFO
Credential:
Phone: 850-576-4073