M D Toxicology Group, LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

M D TOXICOLOGY GROUP, LLC

Practice address

11827 Starcrest Dr
San Antonio, TX 78247-4113

Phone

(512) 531-9214

NPI assigned

Feb 5, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mark Nickle

Title

Administrator

Phone

(210) 882-1705

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1454630400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1463616000000",
    "number": "1518325562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11827 STARCREST DR",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782474113",
            "telephone_number": "512-531-9214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11827 STARCREST DR",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782474113",
            "telephone_number": "512-531-9214"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "M D TOXICOLOGY GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-05",
        "last_updated": "2016-05-19",
        "status": "A",
        "authorized_official_last_name": "NICKLE",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "210-882-1705"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "498429",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS OF TX",
            "identifier": "CL5776",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kenneth M Lyssy Jr., M.D.
• Mary (MK) Kathryn Lyssy, M.S., LPC
• Kathryn Alice Lytle, BSSLP
• M & M Neurology, PLLC
• M & S Tower Pharmacy Inc
• M Fiscus Dao
• M L Wooldridge DDS PLLC
• M M Ontiveros MD PA
• M M Orthodontics PA
• M M Orthodontics PA

• Clinical Medical Laboratory in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Clinical Medical Laboratory in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.