# BONITA COMMUNITY HEALTH CENTER INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** BONITA COMMUNITY HEALTH
- **Organization subpart:** No

## Provider details

- **NPI number:** 1922096999
- **Authorized official:** MS. MIKE RILEY (CEO)
- **Authorized official phone:** (239) 949-6115

## Contact information

- **Practice address:** 3501 HEALTH CENTER BLVD, BONITA SPRINGS, FL 34135-8127
- **Practice address phone:** (239) 949-1050
- **Practice address fax:** (239) 949-6111
- **Mailing address:** 3501 HEALTH CENTER BLVD, BONITA SPRINGS, FL 34135-8127
- **Mailing address phone:** (239) 949-1050
- **Mailing address fax:** (239) 949-6111

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2085R0202X | Diagnostic Radiology Physician | — | — | — |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/12/2005
- **Last updated:** 04/03/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 2728516 00 | — | FL |
| 01 | — | 274894 | AVMED | FL |
| 01 | — | 45737 | BCBS FLORIDA | FL |
| 01 | — | 925030 | AETNA | FL |