MEDICARE: JAY ADOLPHUS SPANN

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	3747P1801X	Personal Care Attendant		MO

General Provider Information

NPI Number	:	1093467938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAY ADOLPHUS SPANN

Provider Business Mailing Address
First Line	:	4233 E ASHLAND AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63115-3304
Country	:	US
Telephone Number	:	314-917-8491
Fax Number	:

Provider Business Practice Location Address
First Line	:	4233 E ASHLAND AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63115-3304
Country	:	US
Telephone Number	:	314-917-8491
Fax Number	:

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

Provider Enumeration Date	:	01/21/2022
Last Update Date	:	01/21/2022

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Directions to “ JAY ADOLPHUS SPANN ” Practice Location

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