Bonner General Hospital, Inc
Organization Active NPI Ophthalmology Physician · Sandpoint, ID
NPI 1104461649 · NPPES record last updated Sep 13, 2024
Key facts
- NPI
- 1104461649
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Ophthalmology Physician 207W00000X
- Legal business name
- BONNER GENERAL HOSPITAL, INC
- Practice address
- 423 N 3Rd Ave Ste 110
Sandpoint, ID 83864-1511 - Phone
- (208) 265-1011
- Fax
- (208) 265-6271
- NPI assigned
- Nov 7, 2019
- Organization subpart
- No
Authorized official
- Name
- John Hennessy
- Title
- Ceo
- Phone
- (208) 265-1100
Other NPIs on the same Medicare enrollment 8
Corporate family (same tax ID) 8
Practitioners 10
-
Stacey A Good, D.O.
-
Natasha M Splaine-Talbott, PMHNP
-
Hans Fredrick Hurt, M.D.
-
Laci Ann Burk, FNP-BC
-
Mark Francis Torres, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040626000014 | ID | Part B Supplier - Clinic/Group Practice | 4082690466 |
Receives reassigned benefits from 75 practitioners 10 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Sandpoint, ID |
National Provider Directory
- Tax ID family
- Bonner General Hospital Inc
Locations
423 N Third Ave
Ste 102
Sandpoint, ID 83864
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician |
207W00000X | Yes |
Addresses
Primary practice location
423 N 3Rd Ave Ste 110
Sandpoint, ID 83864-1511
Mailing address
PO Box 1343
Sandpoint, ID 83864-0863
Phone (208) 265-1158
Other names
- Bonner General Ophthalmology
Other providers in Sandpoint, ID
- Timothy Ray Bonine
- Bonner Area Transit - Commercial
- Bonner County EMS
- Bonner General Hospital Inc
- Bonner General Hospital Inc.
- Bonner General Hospital, Inc
- Bonner General Hospital, Inc
- Bonner General Hospital, Inc
- Bonner General Hospital, Inc
- Bonner General Hospital, Inc
All providers in Sandpoint, ID · Ophthalmology Physician in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 13, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.