Provider Demographics
NPI:1003005232
Name:HAROLD D LEWIS DO PA
Entity Type:Organization
Organization Name:HAROLD D LEWIS DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PRACTITIONER OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:DAVIS
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:512-444-2661
Mailing Address - Street 1:1901 WEST WILLIAM CANNON DRIVE
Mailing Address - Street 2:SUITE 123
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745
Mailing Address - Country:US
Mailing Address - Phone:512-444-2661
Mailing Address - Fax:512-444-2720
Practice Address - Street 1:1901 WEST WILLIAM CANNON DRIVE
Practice Address - Street 2:SUITE 123
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745
Practice Address - Country:US
Practice Address - Phone:512-444-2661
Practice Address - Fax:512-444-2720
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HAROLD D LEWIS DO PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-24
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE6126207Q00000X, 261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10016231OtherAMERIGROUP NUMBER
TX032268701Medicaid
TX00BL17OtherBCBS PIN
TXD97490Medicare UPIN
TX032268701Medicaid