1003462581 NPI number — BUMP HEALTH INC

Table of content: (NPI 1003462581)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003462581 NPI number — BUMP HEALTH INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BUMP HEALTH INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1003462581
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/19/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7719 N PIONEER LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEORIA
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61615-1910
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-913-7879
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7719 N PIONEER LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEORIA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61615-1910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-913-7879
Provider Business Practice Location Address Fax Number:
309-405-0268
Provider Enumeration Date:
08/12/2019

Additional Information

Authorized Official

Authorized Official Last Name:
DEEHRING
Authorized Official First Name:
LELAND
Authorized Official Middle Name:
DANIEL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
888-913-7879

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BP3500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1003462581 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30004828660001 , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5100521 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100201828 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100864750 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 159003 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 620109893 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300065914 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30015097360002 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1003462581 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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