Provider Demographics
NPI:1023048428
Name:MCLAIN, MARIE (PA)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:MCLAIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6550 FANNIN ST
Mailing Address - Street 2:SMITH TOWER, SUITE 1901
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2717
Mailing Address - Country:US
Mailing Address - Phone:713-441-1100
Mailing Address - Fax:713-790-2643
Practice Address - Street 1:6550 FANNIN ST
Practice Address - Street 2:SMITH TOWER, SUITE 1901
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2717
Practice Address - Country:US
Practice Address - Phone:713-441-1100
Practice Address - Fax:713-790-2643
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03576363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1822574Medicaid
TX186442303Medicaid
TX186442304Medicaid
TX8N9776OtherBLUE CROSS BLUE SHIELD
TX186442302Medicaid
TXP00323663OtherRAILROAD MEDICARE
TX186442301Medicaid
TXP01110817OtherRR MEDICARE
TXP01110817OtherRR MEDICARE
TX8N9776OtherBLUE CROSS BLUE SHIELD
TX553159ZSWDMedicare PIN
TX186442303Medicaid