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

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.

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 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:

1013950401

Entity Type Code:

Organization

Replacement NPI:

Last Update Date:

08/22/2020

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

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 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

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

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

• 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".