Provider Demographics
NPI:1093421885
Name:LEWIS, FREDDIE JR
Entity Type:Individual
Prefix:MR
First Name:FREDDIE
Middle Name:
Last Name:LEWIS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 AUBURN DR
Mailing Address - Street 2:
Mailing Address - City:CARENCRO
Mailing Address - State:LA
Mailing Address - Zip Code:70520-4502
Mailing Address - Country:US
Mailing Address - Phone:337-321-1654
Mailing Address - Fax:
Practice Address - Street 1:507 AUBURN DR
Practice Address - Street 2:
Practice Address - City:CARENCRO
Practice Address - State:LA
Practice Address - Zip Code:70520-4502
Practice Address - Country:US
Practice Address - Phone:337-321-1654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
343800000X, 343900000X
LA007495527344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No343800000XTransportation ServicesSecured Medical Transport (VAN)
No344600000XTransportation ServicesTaxi