1184180663 NPI number — MRS. EMILY LEWIS PA

Table of content: MRS. EMILY LEWIS PA (NPI 1184180663)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184180663 NPI number — MRS. EMILY LEWIS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEWIS
Provider First Name:
EMILY
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FARRELL
Provider Other First Name:
EMILY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1184180663
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/17/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15 LA SALLE SQ
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PROVIDENCE
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02903-1814
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-443-5112
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
65 VILLAGE SQUARE DR STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH KINGSTOWN
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02879-2569
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-444-7959
Provider Business Practice Location Address Fax Number:
401-515-7910
Provider Enumeration Date:
02/20/2019

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: 363AM0700X , with the licence number:  PA01508 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1184180663 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".




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