Provider Demographics
NPI:1619165263
Name:LEWIS MEDICAL SUPPLY LLC
Entity Type:Organization
Organization Name:LEWIS MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-826-4170
Mailing Address - Street 1:108 KATIE DR
Mailing Address - Street 2:
Mailing Address - City:RINCON
Mailing Address - State:GA
Mailing Address - Zip Code:31326-5708
Mailing Address - Country:US
Mailing Address - Phone:912-826-4170
Mailing Address - Fax:912-826-3595
Practice Address - Street 1:108 KATIE DR
Practice Address - Street 2:
Practice Address - City:RINCON
Practice Address - State:GA
Practice Address - Zip Code:31326-5708
Practice Address - Country:US
Practice Address - Phone:912-826-4170
Practice Address - Fax:912-826-3595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
4237220001Medicare NSC