MEDICARE: SAMUEL UKOMADU

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	332B00000X	Durable Medical Equipment & Medical Supplies	4654090001	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407999535
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAMUEL UKOMADU

Provider Business Mailing Address
First Line	:	9898 BISSONNET ST STE 250A
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77036-8270
Country	:	US
Telephone Number	:	713-800-0311
Fax Number	:	713-800-0309

Provider Business Practice Location Address
First Line	:	9898 BISSONNET ST STE 250A
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77036-8280
Country	:	US
Telephone Number	:	713-800-0311
Fax Number	:	713-800-0309

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. SAMUEL UKOMADU
Credential	:	MBA
Telephone Number	:	713-800-0311

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	07/02/2012

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