Provider Demographics
NPI:1093430217
Name:LEWIS, AMBER
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 VINTAGE PARK BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-3998
Mailing Address - Country:US
Mailing Address - Phone:281-748-4645
Mailing Address - Fax:
Practice Address - Street 1:9844 CYPRESSWOOD DR APT 304
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-3847
Practice Address - Country:US
Practice Address - Phone:281-748-4645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-10
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX343900000X
343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)