MEDICARE: MR. TY M. TAYLOR LSA,CSA,SA-C

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	246ZC0007X	Surgical Assistant	3618	KS
2	363AS0400X	Surgical Physician Assistant	SA00570	TX

General Provider Information

NPI Number	:	1730223785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TY M. TAYLOR LSA,CSA,SA-C

Provider Business Mailing Address
First Line	:	2915 W BITTERS RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78248-1689
Country	:	US
Telephone Number	:	816-522-7899
Fax Number	:

Provider Business Practice Location Address
First Line	:	2915 W BITTERS RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78248-1689
Country	:	US
Telephone Number	:	816-522-7899
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/16/2007
Last Update Date	:	12/20/2025

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Directions to “ MR. TY M. TAYLOR LSA,CSA,SA-C” Practice Location

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