Provider Demographics
NPI:1417604091
Name:LEWIS LAB SERVICES
Entity Type:Organization
Organization Name:LEWIS LAB SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-949-6228
Mailing Address - Street 1:4144 WAGON WHEEL DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38127-3618
Mailing Address - Country:US
Mailing Address - Phone:901-949-6228
Mailing Address - Fax:901-592-4212
Practice Address - Street 1:4144 WAGON WHEEL DR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38127-3618
Practice Address - Country:US
Practice Address - Phone:901-949-6228
Practice Address - Fax:901-592-4212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-03
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No291U00000XLaboratoriesClinical Medical Laboratory