| Dr Kenneth M Lyssy Jr Md | |
|
6100 Bandera Rd Suite 403 San Antonio TX 78238-1652 | |
| (210) 256-9500 | |
| (210) 256-8720 |
| Full Name | Dr Kenneth M Lyssy Jr Md |
|---|---|
| Speciality | Family Medicine |
| Location | 6100 Bandera Rd, San Antonio, Texas |
| Authorized Official Name and Position | Melissa Souhrada (OFFICE MANAGER) |
| Authorized Official Contact | 2102569500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Kenneth M Lyssy Jr Md 6100 Bandera # 403 San Antonio TX 78238-1653 Ph: (210) 256-9500 | Dr Kenneth M Lyssy Jr Md 6100 Bandera Rd Suite 403 San Antonio TX 78238-1652 Ph: (210) 256-9500 |
| NPI Number | 1205039559 |
|---|---|
| Provider Enumeration Date | 06/06/2007 |
| Last Update Date | 07/02/2008 |
| Medicare PECOS PAC ID | 8426127150 |
|---|---|
| Medicare Enrollment ID | O20080520000776 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205039559 | NPI | - | NPPES |
| 00Z062 | Other | TX | MEDICARE INDIVIDUAL PTAN |
| 00Z062 | Other | TX | MEDICARE GROUP PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Kenneth M Lyssy |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1194718361 PECOS PAC ID: 4981773611 Enrollment ID: I20080520000766 |
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