MEDICARE: KALYPSO TREATMENT CENTERS, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician
2	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1215506787
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KALYPSO TREATMENT CENTERS, PLLC

Provider Business Mailing Address
First Line	:	4600 LOCKHILL SELMA RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-2185
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4730 UNIVERSITY WAY NE STE 104
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98105-4424
Country	:	US
Telephone Number	:	210-862-7246
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	AMY MEISTER
Credential	:	DO
Telephone Number	:	210-862-7246

Provider Enumeration Date	:	06/21/2021
Last Update Date	:	06/21/2021

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