Provider Demographics
NPI:1619205002
Name:LEWIS PC
Entity Type:Organization
Organization Name:LEWIS PC
Other - Org Name:DR LEWIS AND ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:LDO, MSM, MBA
Authorized Official - Phone:931-552-4455
Mailing Address - Street 1:2801 WILMA RUDOLPH BLVD
Mailing Address - Street 2:SUITE 665
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-5011
Mailing Address - Country:US
Mailing Address - Phone:931-552-4455
Mailing Address - Fax:931-552-8999
Practice Address - Street 1:2801 WILMA RUDOLPH BLVD
Practice Address - Street 2:SUITE 665
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-5011
Practice Address - Country:US
Practice Address - Phone:931-552-4455
Practice Address - Fax:931-552-8999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-24
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN0578305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNT61139Medicare UPIN