Provider Demographics
NPI:1205987518
Name:MARY C VALENTINE LSA
Entity type:Organization
Organization Name:MARY C VALENTINE LSA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:C
Authorized Official - Last Name:VALENTINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-974-7419
Mailing Address - Street 1:9800 CENTRE PKWY
Mailing Address - Street 2:SUITE 530
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-8271
Mailing Address - Country:US
Mailing Address - Phone:713-777-4539
Mailing Address - Fax:
Practice Address - Street 1:9800 CENTRE PKWY
Practice Address - Street 2:SUITE 530
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-8271
Practice Address - Country:US
Practice Address - Phone:713-777-4539
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00150363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty