Provider Demographics
NPI:1982825683
Name:LEWISVILLE NEUROLOGY P.A.
Entity Type:Organization
Organization Name:LEWISVILLE NEUROLOGY P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:K
Authorized Official - Last Name:CAMP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-383-1776
Mailing Address - Street 1:3120 MEDPARK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76208-6982
Mailing Address - Country:US
Mailing Address - Phone:940-383-1770
Mailing Address - Fax:940-566-2214
Practice Address - Street 1:3120 MEDPARK DR STE 100
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76208-6982
Practice Address - Country:US
Practice Address - Phone:940-383-1770
Practice Address - Fax:940-566-2214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX335788103Medicaid