45D0975125 CLIA NUMBER - KENNETH M LYSSY JR MD

Laboratory Demographics

  • CLIA Code: 45D0975125
  • Facility Name: KENNETH M LYSSY JR MD
  • Facility Address: 6100 BANDERA RD SUITE 403
    SAN ANTONIO, TX
    ZIP 78238
  • Facility Phone: 210 256-9500
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KENNETH LYSSY
  • NPI Number: 1891792545
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 45D0975125
LAB Type Physician Office
Facility Name KENNETH M LYSSY JR MD
Street 6100 BANDERA RD SUITE 403
City SAN ANTONIO
State TX
ZIP 78238
Phone 210 256-9500
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/27/2024
Certificate Expiration Date 6/26/2026
Facility Type Physician Office
Lab Director KENNETH LYSSY

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This page was last updated on: 9/29/2025