Provider Demographics
NPI:1598040545
Name:PCCSS, PLLC.
Entity type:Organization
Organization Name:PCCSS, PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:MARSHAY
Authorized Official - Middle Name:S
Authorized Official - Last Name:METOYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-988-0850
Mailing Address - Street 1:7500 BEECHNUT
Mailing Address - Street 2:SUITE 250
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074
Mailing Address - Country:US
Mailing Address - Phone:713-988-0850
Mailing Address - Fax:713-988-0866
Practice Address - Street 1:7500 BEECHNUT ST
Practice Address - Street 2:SUITE 250
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-4335
Practice Address - Country:US
Practice Address - Phone:713-988-0850
Practice Address - Fax:713-988-0866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-20
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7264174400000X
207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB126665Medicaid