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General NPI Number Information
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NPI Number | 1447646393
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Entity Type | Organization
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Legal Business Name | LSA SA LLC
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Dates
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Enumeration Date | 04/07/2015
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Last Update Date | 04/07/2015
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Provider Practice Location Address
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Address Line | 8812 BROADWAY ST
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City | SAN ANTONIO
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State | TX
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Zip | 78217-6318
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Country | US
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Telephone | 210-829-5662
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Fax | 210-829-5630
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Provider Business Mailing Address
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Address Line | 8812 BROADWAY ST
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City | SAN ANTONIO
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State | TX
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Zip | 78217-6318
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Country | US
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Telephone | 210-829-5662
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Fax | 210-829-5630
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | TERRY RIELY
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Credential |
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Telephone | 210-410-2563
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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