Provider Demographics
NPI:1548457542
Name:AMUZU, SAMUEL W
Entity type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:W
Last Name:AMUZU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:SWIFT
Other - Middle Name:MEDICAL
Other - Last Name:EQUIPMENT AND SUPPLIES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10039 BISSONNET ST STE 114
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-7838
Mailing Address - Country:US
Mailing Address - Phone:713-271-2331
Mailing Address - Fax:713-272-6280
Practice Address - Street 1:10039 BISSONNET ST STE 114
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-7838
Practice Address - Country:US
Practice Address - Phone:713-271-2331
Practice Address - Fax:713-272-6280
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-03
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0062640332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0062640OtherTEXAS DME LICENSE