MEDICARE: ANGEL RENEE BUMPHUS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1275197188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGEL RENEE BUMPHUS

Provider Business Mailing Address
First Line	:	1634 E MINNESOTA ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46203-2842
Country	:	US
Telephone Number	:	317-993-2473
Fax Number	:

Provider Business Practice Location Address
First Line	:	1634 E MINNESOTA ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46203-2842
Country	:	US
Telephone Number	:	317-993-2473
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2019
Last Update Date	:	05/21/2025

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Directions to “ ANGEL RENEE BUMPHUS ” Practice Location

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