Provider Demographics
NPI:1376040451
Name:AMANDA LEWIS ENTERPRISES LTD
Entity Type:Organization
Organization Name:AMANDA LEWIS ENTERPRISES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-877-1742
Mailing Address - Street 1:3250 N WOODFORD ST
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-2836
Mailing Address - Country:US
Mailing Address - Phone:217-877-1742
Mailing Address - Fax:
Practice Address - Street 1:3250 N WOODFORD ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-2836
Practice Address - Country:US
Practice Address - Phone:217-877-1742
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-06
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment