Provider Demographics
NPI:1861673063
Name:KATHRYN M. LEWIS, M.D., P.A.
Entity Type:Organization
Organization Name:KATHRYN M. LEWIS, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-568-3541
Mailing Address - Street 1:PO BOX 6325
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77325-6325
Mailing Address - Country:US
Mailing Address - Phone:281-360-5400
Mailing Address - Fax:281-548-3513
Practice Address - Street 1:4920 NE STALLINGS DR
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-1254
Practice Address - Country:US
Practice Address - Phone:936-568-3541
Practice Address - Fax:936-568-3390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH05642085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX032010301Medicaid
TX032010301Medicaid
E02190Medicare UPIN