=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548457542
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MR. SAMUEL W AMUZU
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2007
-----------------------------------------------------
Last Update Date | 10/03/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10039 BISSONNET ST STE 114
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77036-7838
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-271-2331
-----------------------------------------------------
Fax | 713-272-6280
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10039 BISSONNET ST STE 114
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77036-7838
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-271-2331
-----------------------------------------------------
Fax | 713-272-6280
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 0062640
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------