Provider Demographics
NPI:1447646393
Name:LSA SA LLC
Entity type:Organization
Organization Name:LSA SA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:RIELY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-410-2563
Mailing Address - Street 1:8812 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-6318
Mailing Address - Country:US
Mailing Address - Phone:210-829-5662
Mailing Address - Fax:210-829-5630
Practice Address - Street 1:8812 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-6318
Practice Address - Country:US
Practice Address - Phone:210-829-5662
Practice Address - Fax:210-829-5630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-07
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory