MEDICARE: SAMUEL BAWCUM

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	146L00000X	Paramedic	26031	NM

General Provider Information

NPI Number	:	1912377169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL BAWCUM

Provider Business Mailing Address
First Line	:	510 BRYN MAWR DR SE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106-2302
Country	:	US
Telephone Number	:	505-710-8418
Fax Number	:

Provider Business Practice Location Address
First Line	:	4259 23RD AVE W
Second Line	:	STE 200
City	:	SEATTLE
State	:	WA
Zip	:	98199-1534
Country	:	US
Telephone Number	:	206-686-4878
Fax Number	:

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

Provider Enumeration Date	:	09/30/2015
Last Update Date	:	09/30/2015

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Directions to “ SAMUEL BAWCUM ” Practice Location

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