1023283041 NPI number — DR. JAMIE BURTON SHUMAKER AU.D

Table of content: AMANDA ROSENAUER CFNP (NPI 1265873251)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023283041 NPI number — DR. JAMIE BURTON SHUMAKER AU.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHUMAKER
Provider First Name:
JAMIE
Provider Middle Name:
BURTON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
AU.D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023283041
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/16/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 GROVE PARK LN STE 800
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOTHAN
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36305-5912
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-702-4327
Provider Business Mailing Address Fax Number:
334-702-4328

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 GROVE PARK LN STE 800
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOTHAN
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36305-5912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-702-4327
Provider Business Practice Location Address Fax Number:
334-702-4328
Provider Enumeration Date:
04/30/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  961A , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 237600000X , with the licence number: 961A , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 515 . This is a "BCBS OF ALABAMA" identifier . This identifiers is of the category "OTHER".