Healthcare Provider Details

I. General information

NPI: 1598040545
Provider Name (Legal Business Name): PCCSS, PLLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2011
Last Update Date: 12/15/2020
Certification Date: 12/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 BEECHNUT ST SUITE 250
HOUSTON TX
77074-4335
US

IV. Provider business mailing address

7500 BEECHNUT SUITE 250
HOUSTON TX
77074
US

V. Phone/Fax

Practice location:
  • Phone: 713-988-0850
  • Fax: 713-988-0866
Mailing address:
  • Phone: 713-988-0850
  • Fax: 713-988-0866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberJ7264
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MARSHAY S METOYER
Title or Position: MEDICAL ASSISTANT
Credential:
Phone: 713-988-0850