Provider Demographics
NPI:1306111315
Name:FIRST AMERICAN MEDICAL
Entity type:Organization
Organization Name:FIRST AMERICAN MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:RAZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-440-0903
Mailing Address - Street 1:1642 WEST BAKER ROAD
Mailing Address - Street 2:SUITE C
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521
Mailing Address - Country:US
Mailing Address - Phone:832-695-2047
Mailing Address - Fax:832-695-2048
Practice Address - Street 1:1642 WEST BAKER ROAD
Practice Address - Street 2:SUITE C
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521
Practice Address - Country:US
Practice Address - Phone:832-695-2047
Practice Address - Fax:832-695-2048
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIRST AMERICAN MEDICAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-09
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1000239332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0860120001Medicaid