Provider Demographics
NPI:1710739719
Name:PSM1 MANAGEMENT LLC
Entity Type:Organization
Organization Name:PSM1 MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PAWAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PANDYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-779-3138
Mailing Address - Street 1:2121 WILLIAMS TRACE BLVD
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-4526
Mailing Address - Country:US
Mailing Address - Phone:281-747-7620
Mailing Address - Fax:
Practice Address - Street 1:2121 WILLIAMS TRACE BLVD STE 300
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4526
Practice Address - Country:US
Practice Address - Phone:281-747-7620
Practice Address - Fax:281-747-7621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-03
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty