MEDICARE: BOND COMMUNITY HEALTH CENTER

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	207R00000X	Internal Medicine Physician	ME80809	FL
2	207QA0505X	Adult Medicine Physician	ME76689	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407109812
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOND COMMUNITY HEALTH CENTER

Provider Business Mailing Address
First Line	:	1720 SOUTH GADSDEN ST
Second Line	:	BOND COMMUNITY HEALTH CENTER
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	:	1549 SOUTH MONROE STREET
Second Line	:	BOND SPECIALITY AND WELLNESS
City	:	TALLAHASSEE
State	:	FL
Zip	:	32301
Country	:	US
Telephone Number	:	850-576-4073
Fax Number	:	850-576-0151

Authorized Official
Title or Position	:	CFO
Name	:	JOHN M GRAYSON
Credential	:
Telephone Number	:	850-576-4073

Provider Enumeration Date	:	10/23/2012
Last Update Date	:	11/16/2016

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Directions to “BOND COMMUNITY HEALTH CENTER ” Practice Location

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