MEDICARE: SAMUEL DEWAINE HOBBS

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	1744P3200X	Prosthetics Case Management
2	101YP2500X	Professional Counselor	83054	TX

General Provider Information

NPI Number	:	1790459527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL DEWAINE HOBBS

Provider Business Mailing Address
First Line	:	14525 FM 529 RD STE 200
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77095-3596
Country	:	US
Telephone Number	:	910-441-9334
Fax Number	:	832-426-7715

Provider Business Practice Location Address
First Line	:	14525 FM 529 RD STE 200
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77095-3596
Country	:	US
Telephone Number	:	910-441-9334
Fax Number	:	832-426-7715

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

Provider Enumeration Date	:	08/04/2021
Last Update Date	:	10/26/2021

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Directions to “ SAMUEL DEWAINE HOBBS ” Practice Location

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