Provider Demographics
NPI:1114068988
Name:DR. VEDA E. LEWIS-SIMMONS DPM MHA LLC
Entity Type:Organization
Organization Name:DR. VEDA E. LEWIS-SIMMONS DPM MHA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VEDA
Authorized Official - Middle Name:E
Authorized Official - Last Name:LEWIS SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM MHA
Authorized Official - Phone:314-323-0669
Mailing Address - Street 1:PO BOX 12
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-0012
Mailing Address - Country:US
Mailing Address - Phone:314-323-0669
Mailing Address - Fax:314-524-4101
Practice Address - Street 1:10421 W FLORISSANT AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-2342
Practice Address - Country:US
Practice Address - Phone:314-524-4100
Practice Address - Fax:314-524-4101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO772213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL08232038OtherILLINOIS BLUE CROSS
MO110194OtherBLUE CROSS BLUE SHIELD
MO2708700OtherUNITED HEALTHCARE
MO50302OtherHEALTHCARE USA
MO5316557OtherAETNA
MO32420OtherGROUP HEALTH PLAN
MO333503OtherHEALTHLINK
IL205061OtherILLINOIS MEDICARE
MO1190000001Medicare NSC
MO32420OtherGROUP HEALTH PLAN