Provider Demographics
NPI:1144717968
Name:SSPMR, PLLC
Entity type:Organization
Organization Name:SSPMR, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGEMENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:DERAMUS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:713-825-8670
Mailing Address - Street 1:1803 W WHITE OAK TER STE B
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-3675
Mailing Address - Country:US
Mailing Address - Phone:713-825-8670
Mailing Address - Fax:936-582-0410
Practice Address - Street 1:1803 W WHITE OAK TER STE B
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-3675
Practice Address - Country:US
Practice Address - Phone:713-825-8670
Practice Address - Fax:936-582-0410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-17
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4108261QM1300X
363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty