Provider Demographics
NPI:1083337380
Name:NYUMA, SAMUEL S
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:S
Last Name:NYUMA
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 1:9896 BISSONNET ST STE 435
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-8162
Mailing Address - Country:US
Mailing Address - Phone:832-997-2299
Mailing Address - Fax:
Practice Address - Street 1:9896 BISSONNET ST STE 435
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-8162
Practice Address - Country:US
Practice Address - Phone:832-997-2299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-21
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX343900000X
344600000X, 343800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No344600000XTransportation ServicesTaxi
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1831576883Medicaid