1467434365 NPI number — DR. MARY S LEWIS M.D.

Table of content: DR. MARY S LEWIS M.D. (NPI 1467434365)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467434365 NPI number — DR. MARY S LEWIS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEWIS
Provider First Name:
MARY
Provider Middle Name:
S
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467434365
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/08/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 950122
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40295-0122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-893-7462
Provider Business Mailing Address Fax Number:
502-212-7551

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4003 KRESGE WAY
Provider Second Line Business Practice Location Address:
SUITE 410
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40207-4652
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-893-7462
Provider Business Practice Location Address Fax Number:
502-212-7551
Provider Enumeration Date:
11/16/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  30196 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 30196 . This is a "KY STATE LICENSE NUMBER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".