1821279290 NPI number — MRS. TRICIA ANNE SHUMATE MS SPEECH LANGUAGE P

Table of content: MRS. TRICIA ANNE SHUMATE MS SPEECH LANGUAGE P (NPI 1821279290)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821279290 NPI number — MRS. TRICIA ANNE SHUMATE MS SPEECH LANGUAGE P

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHUMATE
Provider First Name:
TRICIA
Provider Middle Name:
ANNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS SPEECH LANGUAGE P
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GARSIDE
Provider Other First Name:
TRICIA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1821279290
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/14/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110 MORDINGTON AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLESTOWN
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25414
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-725-9741
Provider Business Mailing Address Fax Number:
304-724-5311

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
103 SHENANDOAH JUNCTION ROAD
Provider Second Line Business Practice Location Address:
TA LOWERY ELEMENTARY SCHOOL
Provider Business Practice Location Address City Name:
SHENANDOAH JUNCTION
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25442
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-728-7250
Provider Business Practice Location Address Fax Number:
304-728-7631
Provider Enumeration Date:
11/14/2007

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: 235Z00000X , with the licence number:  00926758 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0155529000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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