Healthcare Provider Details

I. General information

NPI: 1003130840
Provider Name (Legal Business Name): BOND COMMUNITY HEALTH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2010
Last Update Date: 07/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 S GADSDEN ST
TALLAHASSEE FL
32301-5506
US

IV. Provider business mailing address

1720 S GADSDEN ST
TALLAHASSEE FL
32301-5506
US

V. Phone/Fax

Practice location:
  • Phone: 850-521-5112
  • Fax: 850-521-5108
Mailing address:
  • Phone: 850-521-5112
  • Fax: 850-521-5108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License NumberPH24528
License Number StateFL

VIII. Authorized Official

Name: MR. BERNARD GOODMAAN
Title or Position: CEO
Credential:
Phone: 850-576-4073