Provider Demographics
NPI:1932509635
Name:LEWIS 360 MEDICAL SOLUTIONS PLLC
Entity Type:Organization
Organization Name:LEWIS 360 MEDICAL SOLUTIONS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTONIA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:817-927-8900
Mailing Address - Street 1:2120 MISTLETOE BLVD UNIT 2
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76110-1174
Mailing Address - Country:US
Mailing Address - Phone:817-927-8900
Mailing Address - Fax:817-927-8902
Practice Address - Street 1:2120 MISTLETOE BLVD UNIT 2
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76110-1174
Practice Address - Country:US
Practice Address - Phone:817-927-8900
Practice Address - Fax:817-927-8902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-29
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX532304163W00000X
TX40272207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty