Provider Demographics
NPI:1174910798
Name:LEWIS, ERICA D
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:D
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:PO BOX 411042
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75241-8042
Mailing Address - Country:US
Mailing Address - Phone:972-774-8231
Mailing Address - Fax:214-397-4600
Practice Address - Street 1:323 W PARK PLACE DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:TX
Practice Address - Zip Code:75134-3251
Practice Address - Country:US
Practice Address - Phone:214-402-0282
Practice Address - Fax:214-397-4600
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-21
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
247200000X
TX07239808343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other