Bonita Emergency Group, LLC

Organization Active NPI Emergency Medicine Physician · Meridian, MS

NPI 1992563969 · NPPES record last updated Mar 13, 2024

Key facts

NPI
1992563969
Entity type
Organization (NPI type 2)
Primary specialty
Emergency Medicine Physician 207P00000X
Legal business name
BONITA EMERGENCY GROUP, LLC
Practice address
1314 19TH Ave
Meridian, MS 39301-4116
Phone
(601) 483-0011
Fax
(601) 483-4384
NPI assigned
Mar 13, 2024
Organization subpart
No

Authorized official

Name
Lisha C Falk
Title
VP of Contracting
Phone
(337) 609-1221

Practitioners 41

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 41

Medicare participation

Medicare fee-for-service enrollment
Enrolled in MS

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20240502001459 MS Part B Supplier - Clinic/Group Practice 3870933278 Receives reassigned benefits from 41 practitioners
Practice locations: Meridian, MS

National Provider Directory

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP
207P00000X Yes
Physician Assistant
Group: 193200000X MULTI-SPECIALTY GROUP
363A00000X
Nurse Practitioner
Group: 193200000X MULTI-SPECIALTY GROUP
363L00000X

Addresses

Primary practice location

1314 19TH Ave
Meridian, MS 39301-4116

Mailing address

200 Corporate Blvd
Lafayette, LA 70508-3870
Phone (800) 893-9698

Other providers in Meridian, MS

All providers in Meridian, MS · Emergency Medicine Physician in Mississippi

Sources for this page

Verify at the official NPI Registry.