Provider Demographics
NPI:1205032190
Name:SETH R LEWIS MD PC
Entity Type:Organization
Organization Name:SETH R LEWIS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-475-5100
Mailing Address - Street 1:555 E 5300 S STE 7
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84405-4509
Mailing Address - Country:US
Mailing Address - Phone:801-475-5100
Mailing Address - Fax:801-475-8580
Practice Address - Street 1:555 E 5300 S STE 7
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-4509
Practice Address - Country:US
Practice Address - Phone:801-475-5100
Practice Address - Fax:801-475-8580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT528641867027Medicaid
UT264301-1205OtherSTATE LICENSE NUMBER
UTF91544OtherUPIN
1851409544OtherINDIVIDUAL NPI
000060812OtherPTAN