Provider Demographics
NPI:1053932608
Name:BSISA PLLC
Entity type:Organization
Organization Name:BSISA PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MD
Authorized Official - Prefix:
Authorized Official - First Name:OSAMA
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-625-4733
Mailing Address - Street 1:PO BOX 4585, MSC#700
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4595
Mailing Address - Country:US
Mailing Address - Phone:210-625-4733
Mailing Address - Fax:210-625-4734
Practice Address - Street 1:12709 TOEPPERWEIN RD STE 101
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3259
Practice Address - Country:US
Practice Address - Phone:210-625-4733
Practice Address - Fax:210-625-4734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-05
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXR0681OtherLICENSE