MEDICARE: LONESTAR VISITING PHYSICIANS LLC

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1609414937
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LONESTAR VISITING PHYSICIANS LLC

Provider Business Mailing Address
First Line	:	4115 MEDICAL DR STE 301
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-5622
Country	:	US
Telephone Number	:	210-390-6911
Fax Number	:

Provider Business Practice Location Address
First Line	:	4115 MEDICAL DR STE 301
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-5622
Country	:	US
Telephone Number	:	210-390-6911
Fax Number	:	210-890-8711

Authorized Official
Title or Position	:	OWNER
Name	:	ALEXIS SOUTHWELL
Credential	:
Telephone Number	:	210-400-8460

Provider Enumeration Date	:	12/17/2019
Last Update Date	:	01/06/2025

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