Provider Demographics
NPI:1073504437
Name:CHARLES DERON LEWIS
Entity Type:Organization
Organization Name:CHARLES DERON LEWIS
Other - Org Name:RELIABLE HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PROPRIETOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:DERON
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-694-2285
Mailing Address - Street 1:PO BOX 187
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:TX
Mailing Address - Zip Code:75633
Mailing Address - Country:US
Mailing Address - Phone:903-694-2285
Mailing Address - Fax:903-694-9658
Practice Address - Street 1:310 N ADAMS STREET
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:TX
Practice Address - Zip Code:75633
Practice Address - Country:US
Practice Address - Phone:903-694-2285
Practice Address - Fax:903-694-9658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-03
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX010568601Medicaid
TX016517701Medicaid
TX530941OtherBCBS
TX530941OtherBCBS