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Kenyatta Y Lee

Family Medicine

Allopathic & Osteopathic Physicians

903 W Martin St, San Antonio, TX 78207-0903

PECOS Enrollment

This provider is enrolled in PECOS as KENYATTA LEE.

Based on the most recent information from CMS, provider Kenyatta Y Lee is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1588633630
Provider Type
Individual
Full Name
Lee, Kenyatta Y
Title
Dr.
Credential
MD

Gender
Male
Sole Proprietor
No
Enumeration Date
3/14/2006
Last Updated
1/2/2018

Contact Information

Practice Location

903 W Martin St, San Antonio, TX 78207-0903

(210) 358-5942

Unlisted Fax

Mailing Location

7703 Floyd Curl Dr # Mc7977, San Antonio, TX 78229-3901

(210) 358-3985

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 207Q00000X Primary	Description Family Medicine Allopathic & Osteopathic Physicians	License R3548 Texas

Provider Identifiers

ID	Description	Issuer
ID 312995964A	Description Medicaid	Issuer Unlisted Georgia
ID 377442401	Description Medicaid	Issuer Unlisted Texas
ID 2701022-00	Description Medicaid	Issuer Unlisted Florida
ID 270102200	Description Medicaid	Issuer Unlisted Florida
ID P00191364	Description Other	Issuer RAILROAD MEDICARE Florida

Kenyatta Y Lee

PECOS Enrollment

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