Organization
JOSEPH E BONELLI, MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH E BONELLI MD (MEDICAL DIRECTOR)
(970) 522-0122
Entity
Organization
Contact information
Practice address
615 FAIRHURST ST, STERLING, CO 80751-4564
(970) 522-0122
Mailing address
PO BOX 7643, LOVELAND, CO 80537-0643
(970) 663-2742
(970) 667-0847
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
27063
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01276039
—
CO
01
—
06D0516879
CLIA
CO
01
—
220009129
RAILROAD MEDICARE
CO
01
—
M31406
PINNACOL
CO
Enumeration date
06/01/2006
Last updated
02/17/2011
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