Provider Demographics
NPI:1588859573
Name:FAYETTE MEDICAL
Entity Type:Organization
Organization Name:FAYETTE MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BELEMA
Authorized Official - Middle Name:ALEX
Authorized Official - Last Name:AMACHREE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-877-2116
Mailing Address - Street 1:1513 FANNIN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:COLUMBUS
Mailing Address - State:TX
Mailing Address - Zip Code:78934-2515
Mailing Address - Country:US
Mailing Address - Phone:832-877-2116
Mailing Address - Fax:281-530-4337
Practice Address - Street 1:1513 FANNIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:COLUMBUS
Practice Address - State:TX
Practice Address - Zip Code:78934-2515
Practice Address - Country:US
Practice Address - Phone:832-877-2116
Practice Address - Fax:281-530-4337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0097214332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies