MEDICARE: MR. SAMUEL MAYER HYDE MMSC

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	170300000X	Genetic Counselor (M.S.)

General Provider Information

NPI Number	:	1083119440
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SAMUEL MAYER HYDE MMSC

Provider Business Mailing Address
First Line	:	1400 PRESSLER ST # 17.5037
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-3722
Country	:	US
Telephone Number	:	713-792-6691
Fax Number	:	713-745-1921

Provider Business Practice Location Address
First Line	:	1400 PRESSLER ST # 17.5037
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-3722
Country	:	US
Telephone Number	:	713-792-6691
Fax Number	:	713-745-1921

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

Provider Enumeration Date	:	03/28/2018
Last Update Date	:	03/28/2018

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