MEDICARE: MARY C CARR-VALENTINE LSA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246ZC0007X	Surgical Assistant

General Provider Information

NPI Number	:	1659429546
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY C CARR-VALENTINE LSA

Provider Business Mailing Address
First Line	:	PO BOX 3025
Second Line	:	530
City	:	HOUSTON
State	:	TX
Zip	:	77253-3025
Country	:	US
Telephone Number	:	713-271-2384
Fax Number	:	281-833-8950

Provider Business Practice Location Address
First Line	:	6560 FANNIN ST
Second Line	:	1610
City	:	HOUSTON
State	:	TX
Zip	:	77030-2761
Country	:	US
Telephone Number	:	713-271-2384
Fax Number	:	281-833-8950

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	03/27/2019

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