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General NPI Number Information
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NPI Number | 1407207392
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Entity Type | Organization
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Legal Business Name | TSA CLINIC PLLC
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Dates
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Enumeration Date | 06/22/2016
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Last Update Date | 07/25/2016
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Provider Practice Location Address
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Address Line | 3160 N TARRANT PKWY STE 404
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City | FORT WORTH
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State | TX
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Zip | 76177-8614
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Country | US
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Telephone | 972-707-0005
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Fax |
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Provider Business Mailing Address
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Address Line | 3160 N TARRANT PKWY STE 404
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City | FORT WORTH
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State | TX
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Zip | 76177-8614
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Country | US
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Telephone | 972-707-0005
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MARK C VALENTE
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Credential | D.O.
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Telephone | 972-707-0005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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