Provider Demographics
NPI:1457508467
Name:SAMCOOKE MEDICAL SUPPLIES, INC.
Entity Type:Organization
Organization Name:SAMCOOKE MEDICAL SUPPLIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:NNANNA
Authorized Official - Middle Name:O
Authorized Official - Last Name:OKORAFOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-291-1867
Mailing Address - Street 1:2601 WOODLAND PARK DR APT 4110
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-6166
Mailing Address - Country:US
Mailing Address - Phone:713-291-1867
Mailing Address - Fax:
Practice Address - Street 1:6200 SAVOY DR STE 265
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-3324
Practice Address - Country:US
Practice Address - Phone:713-291-1867
Practice Address - Fax:832-848-1481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-20
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0074991332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies