Provider Demographics
NPI:1679655153
Name:DUMAS FAMILY PRACTICE, LLC
Entity Type:Organization
Organization Name:DUMAS FAMILY PRACTICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:L
Authorized Official - Last Name:BUNCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-935-9005
Mailing Address - Street 1:PO BOX 755
Mailing Address - Street 2:
Mailing Address - City:DUMAS
Mailing Address - State:TX
Mailing Address - Zip Code:79029-0755
Mailing Address - Country:US
Mailing Address - Phone:806-935-9005
Mailing Address - Fax:806-935-5885
Practice Address - Street 1:120 BEARD AVE
Practice Address - Street 2:
Practice Address - City:DUMAS
Practice Address - State:TX
Practice Address - Zip Code:79029-4003
Practice Address - Country:US
Practice Address - Phone:806-935-9005
Practice Address - Fax:806-395-5885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
TXH8594261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112651802Medicaid
TX112651802Medicaid