Provider Demographics
NPI:1225467517
Name:PHYSICIAN SUPPORT SERVICES PLLC
Entity Type:Organization
Organization Name:PHYSICIAN SUPPORT SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHIQUEALI
Authorized Official - Middle Name:I
Authorized Official - Last Name:POONAWALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-890-6800
Mailing Address - Street 1:13325 HARGRAVE ROAD
Mailing Address - Street 2:SUITE 190
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-4540
Mailing Address - Country:US
Mailing Address - Phone:281-890-6800
Mailing Address - Fax:281-890-6865
Practice Address - Street 1:13325 HARGRAVE RD
Practice Address - Street 2:SUITE 190
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-4539
Practice Address - Country:US
Practice Address - Phone:281-890-6800
Practice Address - Fax:281-890-6865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-06
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX801606254261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care