Provider Demographics
NPI:1801339957
Name:BUMP, EARL JR
Entity type:Individual
Prefix:
First Name:EARL
Middle Name:
Last Name:BUMP
Suffix:JR
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 1:504 MAIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05201-2111
Mailing Address - Country:US
Mailing Address - Phone:802-442-9052
Mailing Address - Fax:
Practice Address - Street 1:504 MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201-2111
Practice Address - Country:US
Practice Address - Phone:802-442-9052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-22
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT21209775347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1026752Medicaid