Provider Demographics
NPI:1689391914
Name:KAMAU, SAMUEL GACHOMBA
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:GACHOMBA
Last Name:KAMAU
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 1:1090 RANDELL CT
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-4326
Mailing Address - Country:US
Mailing Address - Phone:314-719-7250
Mailing Address - Fax:
Practice Address - Street 1:1090 RANDELL CT
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-4326
Practice Address - Country:US
Practice Address - Phone:314-719-7250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-26
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)