Provider Demographics
NPI:1356587497
Name:MINERAL KING SURGICAL ASSOCIATES, INC.
Entity type:Organization
Organization Name:MINERAL KING SURGICAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:TONI
Authorized Official - Middle Name:M
Authorized Official - Last Name:BONISKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-732-5290
Mailing Address - Street 1:PO BOX 7436
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93290-7436
Mailing Address - Country:US
Mailing Address - Phone:559-622-8500
Mailing Address - Fax:559-622-9410
Practice Address - Street 1:5533 W HILLSDALE AVE
Practice Address - Street 2:SUITE C
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-5138
Practice Address - Country:US
Practice Address - Phone:559-622-8500
Practice Address - Fax:559-622-9410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-19
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma SurgeryGroup - Single Specialty