Provider Demographics
NPI:1275789067
Name:EDWARD S LEWIS, MDPA
Entity Type:Organization
Organization Name:EDWARD S LEWIS, MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-346-7170
Mailing Address - Street 1:11623 ANGUS RD STE 15
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-4041
Mailing Address - Country:US
Mailing Address - Phone:512-346-7170
Mailing Address - Fax:
Practice Address - Street 1:11623 ANGUS RD STE 15
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-4041
Practice Address - Country:US
Practice Address - Phone:512-346-7170
Practice Address - Fax:512-345-2699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF3210174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00317VMedicare PIN