Provider Demographics
NPI:1558308262
Name:LELA M LEWIS
Entity Type:Organization
Organization Name:LELA M LEWIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LELA
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-739-0948
Mailing Address - Street 1:3683 NC 211 HWY WEST
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28360
Mailing Address - Country:US
Mailing Address - Phone:910-739-0948
Mailing Address - Fax:910-738-6774
Practice Address - Street 1:3683 NC 211 HWY WEST
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28360
Practice Address - Country:US
Practice Address - Phone:910-739-0948
Practice Address - Fax:910-738-6774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7703840Medicaid
NC7703840Medicaid