Southwest LTC - Bonner LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

SOUTHWEST LTC - BONNER LLC

Doing business as

Legacy at Jacksonville

Practice address

810 Bellaire St
Jacksonville, TX 75766-9045

Phone

(903) 589-5300

NPI assigned

Apr 21, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ronald Payne

Title

President

Phone

(469) 916-6100

Specialties & licenses 1

Addresses

Other names 1

• Legacy at Jacksonville Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1555804800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1555804800000",
    "number": "1033772413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5560 TENNYSON PKWY STE 210",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750243582",
            "telephone_number": "469-916-6100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "810 BELLAIRE ST",
            "city": "JACKSONVILLE",
            "state": "TX",
            "postal_code": "757669045",
            "telephone_number": "903-589-5300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWEST LTC - BONNER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-21",
        "last_updated": "2019-04-21",
        "status": "A",
        "authorized_official_last_name": "PAYNE",
        "authorized_official_first_name": "RONALD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "469-916-6100"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Legacy at Jacksonville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Gary E Smith, MD
• Honey Michelle Smith, FNP
• Jordan Victoria Smith, COTA
• Mary Maegan Smith
• Sammy Lee Smith, D.C.
• Special Health Resources for Texas, Incorporated (True North Health Center)
• Christy Michelle Spell
• Melissa A Springmeyer, M.D.
• Dennis Raymond Steelman, LPC
• Charles Martin Stocks, DDS

• Skilled Nursing Facility in Jacksonville, TX
• Providers in Jacksonville, TX by specialty
• Skilled Nursing Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.