Provider Demographics
NPI:1447032024
Name:BUMM, BOBBY LEE
Entity type:Individual
Prefix:
First Name:BOBBY
Middle Name:LEE
Last Name:BUMM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:490 HILLGAIL CIR SW
Mailing Address - Street 2:
Mailing Address - City:PATASKALA
Mailing Address - State:OH
Mailing Address - Zip Code:43062-9137
Mailing Address - Country:US
Mailing Address - Phone:740-919-5531
Mailing Address - Fax:
Practice Address - Street 1:490 HILLGAIL CIR SW
Practice Address - Street 2:
Practice Address - City:PATASKALA
Practice Address - State:OH
Practice Address - Zip Code:43062-9137
Practice Address - Country:US
Practice Address - Phone:740-919-5531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker