Active NPI
Lissy Kochuplackal Menachery, MD
- Family Medicine Physician
- Columbia, SC
National Provider Identifier
1801993290
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 15188
- Practice address
- 4500 Stuart Street
Moncrief Army Hospital Attn MCXL-PQ (Credentials)
Columbia, SC 29207-5700 - Phone
- (803) 751-2618
- Fax
- (803) 751-2689
- NPI assigned
- Sep 20, 2006
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15188 | SC | MD | Family Medicine Physician |
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 15188 | SC | Primary |
Addresses
Primary practice location
4500 Stuart Street
Moncrief Army Hospital Attn MCXL-PQ (Credentials)
Columbia, SC 29207-5700
Mailing address
4500 Stuart St
Moncrief Army Hospital Attn MCXL-PQ (Credentials)
Columbia, SC 29207-5700
Phone (803) 751-2618
NPI Registry JSON
{
"created_epoch": "1158710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1801993290",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4500 STUART ST",
"address_2": "MONCRIEF ARMY HOSPITAL ATTN MCXL-PQ (CREDENTIALS)",
"city": "COLUMBIA",
"state": "SC",
"postal_code": "292075700",
"telephone_number": "803-751-2618",
"fax_number": "803-751-2689"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4500 STUART STREET",
"address_2": "MONCRIEF ARMY HOSPITAL ATTN MCXL-PQ (CREDENTIALS)",
"city": "COLUMBIA",
"state": "SC",
"postal_code": "292075700",
"telephone_number": "803-751-2618",
"fax_number": "803-751-2689"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MENACHERY",
"first_name": "LISSY",
"middle_name": "KOCHUPLACKAL",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-09-20",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "SC",
"license": "15188",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Columbia, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.