Provider Demographics
NPI:1851999130
Name:LEWIS, GEOFF
Entity Type:Individual
Prefix:
First Name:GEOFF
Middle Name:
Last Name:LEWIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6904 JOSEPH DR
Mailing Address - Street 2:
Mailing Address - City:ENON
Mailing Address - State:OH
Mailing Address - Zip Code:45323-1448
Mailing Address - Country:US
Mailing Address - Phone:937-543-1050
Mailing Address - Fax:
Practice Address - Street 1:6904 JOSEPH DR
Practice Address - Street 2:
Practice Address - City:ENON
Practice Address - State:OH
Practice Address - Zip Code:45323-1448
Practice Address - Country:US
Practice Address - Phone:937-543-1050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care