Provider Demographics
NPI:1407207392
Name:TSA CLINIC PLLC
Entity Type:Organization
Organization Name:TSA CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:C
Authorized Official - Last Name:VALENTE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:972-707-0005
Mailing Address - Street 1:3160 N TARRANT PKWY STE 404
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76177-8614
Mailing Address - Country:US
Mailing Address - Phone:972-707-0005
Mailing Address - Fax:
Practice Address - Street 1:3160 N TARRANT PKWY STE 404
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76177-8614
Practice Address - Country:US
Practice Address - Phone:972-707-0005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-22
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty