Healthcare Provider Details

I. General information

NPI: 1295056877
Provider Name (Legal Business Name): PCCSS, PLLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2010
Last Update Date: 12/15/2020
Certification Date: 12/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 BEECHNUT ST. STE. 250
HOUSTON TX
77074-4396
US

IV. Provider business mailing address

7500 BEECHNUT ST. STE. 250
HOUSTON TX
77074-4396
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 Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

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