Provider Demographics
NPI:1750410577
Name:LEWIS-ECHOLS, ANDREA C (M D)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:C
Last Name:LEWIS-ECHOLS
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 E 3RD STREET
Mailing Address - Street 2:
Mailing Address - City:HOPE
Mailing Address - State:AR
Mailing Address - Zip Code:71801-3435
Mailing Address - Country:US
Mailing Address - Phone:870-722-1020
Mailing Address - Fax:870-722-5279
Practice Address - Street 1:802 E 3RD STREET
Practice Address - Street 2:
Practice Address - City:HOPE
Practice Address - State:AR
Practice Address - Zip Code:71801-3435
Practice Address - Country:US
Practice Address - Phone:870-722-1020
Practice Address - Fax:870-722-5279
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-5725207P00000X
ARE5725207Q00000X
LAMD.202062207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1792977Medicaid
AR175790001Medicaid
AR5H405OtherBLUE SHIELD
LA1792977Medicaid