1558303552 NPI number — ROBERT SHUMATE PT

Table of content: ROBERT SHUMATE PT (NPI 1558303552)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558303552 NPI number — ROBERT SHUMATE PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHUMATE
Provider First Name:
ROBERT
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
M

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:
1558303552
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11700 MUKILTEO SPEEDWAY
Provider Second Line Business Mailing Address:
SUITE 503
Provider Business Mailing Address City Name:
MUKILTEO
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98275-5432
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-349-9692
Provider Business Mailing Address Fax Number:
425-349-9694

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11700 MUKILTEO SPEEDWAY
Provider Second Line Business Practice Location Address:
SUITE 503
Provider Business Practice Location Address City Name:
MUKILTEO
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98275-5432
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-349-9692
Provider Business Practice Location Address Fax Number:
425-349-9694
Provider Enumeration Date:
06/12/2006

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: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 8904846 . This is a "CRIME VICTIMS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8342156 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0195095 . This is a "LABOR & INDUSTRY" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 5305SH . This is a "REGENCE RIDER #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 911745305-98275-A012 . This is a "TRICARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8342156 . This is a "DSHS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7322199 . This is a "AETNA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: P00317846 . This is a "RR MEDICARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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