Healthcare Provider Details

I. General information

NPI: 1811211063
Provider Name (Legal Business Name): PCRMC - BOND CLINIC MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2010
Last Update Date: 09/17/2020
Certification Date: 09/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 BLUES LAKE PKWY
ROLLA MO
65401-8022
US

IV. Provider business mailing address

600 BLUES LAKE PKWY
ROLLA MO
65401-8022
US

V. Phone/Fax

Practice location:
  • Phone: 573-364-8822
  • Fax: 573-341-5969
Mailing address:
  • Phone: 573-364-8822
  • Fax: 573-341-5969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR8583
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number30610
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR7D34
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberR7812
License Number StateMO
# 5
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number114610
License Number StateMO
# 6
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2006036024
License Number StateMO
# 7
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number119445
License Number StateMO
# 8
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number2001015853
License Number StateMO
# 9
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number117468
License Number StateMO
# 10
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number112148
License Number StateMO
# 11
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2006005292
License Number StateMO
# 12
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number2006001740
License Number StateMO
# 13
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number128892
License Number StateMO
# 14
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2002005692
License Number StateMO
# 15
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number116667
License Number StateMP

VIII. Authorized Official

Name: DR. CATHY BOND
Title or Position: MEDICAL DIRECTOR
Credential: D.O.
Phone: 573-364-8822