MEDICARE: TYRONE DUMAS

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	261QA0600X	Adult Day Care Clinic/Center	1563	MO

General Provider Information

NPI Number	:	1871058560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYRONE DUMAS

Provider Business Mailing Address
First Line	:	12060 BELLEFONTAINE RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63138-1903
Country	:	US
Telephone Number	:	314-764-2099
Fax Number	:	314-764-2152

Provider Business Practice Location Address
First Line	:	12060 BELLEFONTAINE RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63138-1903
Country	:	US
Telephone Number	:	314-764-2099
Fax Number	:	314-764-2152

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

Provider Enumeration Date	:	02/06/2019
Last Update Date	:	02/06/2019

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Directions to “ TYRONE DUMAS ” Practice Location

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