1013950401 NPI number — BON-BONE MEDICAL IMAGING, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013950401 NPI number — BON-BONE MEDICAL IMAGING, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BON-BONE MEDICAL IMAGING, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013950401
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7040 SEMINOLE PRATT WHITNEY RD
Provider Second Line Business Mailing Address:
STE. 25-166
Provider Business Mailing Address City Name:
LOXAHATCHEE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33470-2468
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-664-2663
Provider Business Mailing Address Fax Number:
561-792-5199

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6499 38TH AVE N
Provider Second Line Business Practice Location Address:
SUITE G2
Provider Business Practice Location Address City Name:
ST PETERSBURG
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33710-1656
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-341-2866
Provider Business Practice Location Address Fax Number:
727-341-2876
Provider Enumeration Date:
06/13/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HARDY
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
561-753-8557

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 579259 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 102686 . This is a "AVMED" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 137014 . This is a "PREFERRED CARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 2243437 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 2243421 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 2592718 . This is a "GHI" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: V1836 . This is a "BC/BS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: V1267 . This is a "BC/BS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 7723768 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: V1173 . This is a "BC/BS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: V1761 . This is a "BC/BS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 2243431 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".