MEDICARE: PSM1 MANAGEMENT LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist
2	207RG0300X	Geriatric Medicine (Internal Medicine) Physician

General Provider Information

NPI Number	:	1710739719
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PSM1 MANAGEMENT LLC

Provider Business Mailing Address
First Line	:	2121 WILLIAMS TRACE BLVD
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77478-4526
Country	:	US
Telephone Number	:	281-747-7620
Fax Number	:

Provider Business Practice Location Address
First Line	:	2121 WILLIAMS TRACE BLVD STE 300
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77478-4526
Country	:	US
Telephone Number	:	281-747-7620
Fax Number	:	281-747-7621

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	PAWAN PANDYA
Credential	:
Telephone Number	:	409-779-3138

Provider Enumeration Date	:	04/03/2024
Last Update Date	:	12/11/2024

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Directions to “PSM1 MANAGEMENT LLC ” Practice Location

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