Provider Demographics
NPI:1720732605
Name:SHUMAKE, ERNEST SCOTT
Entity Type:Individual
Prefix:
First Name:ERNEST
Middle Name:SCOTT
Last Name:SHUMAKE
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 1:90 OLD STONE DR
Mailing Address - Street 2:
Mailing Address - City:SUMMERSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26651-1668
Mailing Address - Country:US
Mailing Address - Phone:304-619-7885
Mailing Address - Fax:
Practice Address - Street 1:90 OLD STONE DR
Practice Address - Street 2:
Practice Address - City:SUMMERSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26651-1668
Practice Address - Country:US
Practice Address - Phone:304-619-7885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-09
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant