Keith A Bonacquisti (NPI# 1487773669, PAC ID# 1153339825) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is OTOLARYNGOLOGY.
| Nation Provider ID (NPI) | 1487773669 |
| PAC ID by PECOS | 1153339825 |
| Professional Enrollment ID | I20120104000462 |
| Full Name | Keith A Bonacquisti |
| Organization Legal Name | LAKE REGIONAL MEDICAL MANAGEMENT, INC. |
| Address |
1029 Nicholas Rd 301 Lake Regional Ent and Audiology Osage Beach MO 65065-3008 |
| Phone Number | 5733022864 |
| Gender | M |
| Graduation Year | 1985 |
| Primary Specialty | OTOLARYNGOLOGY |
| Group Practice PAC ID | 3577467323 |
| Number of Group Practice Members | 33 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 140052 | OSF SAINT ANTHONY'S HEALTH CENTER |
| 260186 | LAKE REGIONAL HEALTH SYSTEM |
| 140289 | ANDERSON HOSPITAL |
| Address | Phone | Organization |
|---|---|---|
| 1029 Nicholas Rd, 301 Lake Regional Ent and Audiology, Osage Beach, MO 65065-3008 | 5733022864 | LAKE REGIONAL MEDICAL MANAGEMENT, INC. |
| Organization Legal Name | LAKE REGIONAL MEDICAL MANAGEMENT, INC. |
| Physicians | 34 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Eric R Varboncouer | Orthopedic Surgery | Lake Regional Medical Management, Inc. | 1075 Nichols Rd, Suite 1 2, Osage Beach, MO 65065-3093 |
| Kevin G Byrne | Internal Medicine | Lake Regional Medical Management, Inc. | 1029 Nichols Rd, 201 Lake Regional Gastroenterology, Osage Beach, MO 65065-3008 |
| Zubair A Khan | Cardiovascular Disease (cardiology) | Lake Regional Medical Management, Inc. | 416 S Maple C, Lake Regional Clinic Eldon, Eldon, MO 65026-1808 |
| Brian Swanson | Physician Assistant | Lake Regional Medical Management, Inc. | 54 Hospital Dr, Osage Beach, MO 65065-3050 |
| Scott J Brick | General Surgery | Lake Regional Medical Management, Inc. | 54 Hospital Dr, Osage Beach, MO 65065-3050 |
| Philip J Kurle | Neurology | Lake Regional Medical Management, Inc. | 54 Hospital Dr, Osage Beach, MO 65065-3050 |
| John C Patton | General Surgery | Lake Regional Medical Management, Inc. | 54 Hospital Dr, Osage Beach, MO 65065-3050 |
| Stacy L Sederwall | Nurse Practitioner | Lake Regional Medical Management, Inc. | 54 Hospital Dr, Osage Beach, MO 65065-3050 |
| Valerie Dalphine Donnelson | Physician Assistant | Lake Regional Medical Management, Inc. | 54 Hospital Dr, Osage Beach, MO 65065-3050 |
| Scott L Hofer | Orthopedic Surgery | Lake Regional Medical Management, Inc. | 1075 Nichols Rd, Suite 3, Osage Beach, MO 65065-3094 |
| Street Address |
1029 NICHOLAS RD 301 LAKE REGIONAL ENT AND AUDIOLOGY |
| City | OSAGE BEACH |
| State | MO |
| Zip | 65065-3008 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Angela Foster | Chiropractic | 4681 Hwy 54 Kings Plz 6, Osage Beach, MO 65065 | |
| Charles H Pike Iii | Chiropractic | Pike Chiropractic | 4075 Osage Beach Pkwy, Suite 200, Osage Beach, MO 65065-2153 |
| Amy S Pike | Chiropractic | Pike Chiropractic | 4075 Osage Beach Pkwy, Suite 200, Osage Beach, MO 65065-2153 |
| Karen S Hayes | Nurse Practitioner | Nhc Reliant Psychiatric Services LLC | 840 Passover Rd, Osage Beach, MO 65065-2834 |
| Jeannie M Carlton | Nurse Practitioner | Nhc Reliant Psychiatric Services LLC | 840 Passover Rd, Osage Beach, MO 65065-2834 |
| Christine A Livek | Family Medicine | Nhc Reliant Psychiatric Services LLC | 840 Passover Rd, Osage Beach, MO 65065-2834 |
| Gwendolyn Ann Broyles | Nurse Practitioner | Nhc Reliant Psychiatric Services LLC | 840 Passover Rd, Osage Beach, MO 65065-2834 |
| Laura M Thompson | Nurse Practitioner | Nhc Reliant Psychiatric Services LLC | 840 Passover Rd, Osage Beach, MO 65065-2834 |
| Kenneth J Fattmann | Psychiatry | Nhc Reliant Psychiatric Services LLC | 840 Passover Rd, Osage Beach, MO 65065-2834 |
| Benny E Thomas | Family Practice | 840 Passover Rd, Osage Beach, MO 65065-2834 | |
| Find all physicians in zip 65065 | |||
| City | OSAGE BEACH |
| Zip Code | 65065 |
| Specialty | OTOLARYNGOLOGY |
| City + Specialty | OSAGE BEACH + OTOLARYNGOLOGY |
Please comment or provide details below to improve the information on Keith A Bonacquisti.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.