Provider Demographics
NPI:1104538297
Name:FAHM, SAMSON O
Entity type:Individual
Prefix:
First Name:SAMSON
Middle Name:O
Last Name:FAHM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 BRAND LN STE 903
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-4801
Mailing Address - Country:US
Mailing Address - Phone:832-707-7390
Mailing Address - Fax:208-248-3482
Practice Address - Street 1:111 BRAND LN STE 903
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-4801
Practice Address - Country:US
Practice Address - Phone:832-707-7390
Practice Address - Fax:208-248-3482
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-20
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)