Healthcare Provider Details

I. General information

NPI: 1336100791
Provider Name (Legal Business Name): JIMMIE D. LUMMUS DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 10/18/2022
Certification Date: 10/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 HUTCHINS AVE STE C
BALLINGER TX
76821-4453
US

IV. Provider business mailing address

PO BOX 617
BALLINGER TX
76821-0617
US

V. Phone/Fax

Practice location:
  • Phone: 325-365-5737
  • Fax:
Mailing address:
  • Phone: 325-365-2531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number0847
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number0847
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0847
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: