1285740159 NPI number — ELIZABETH A LEWIS D.O.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285740159 NPI number — ELIZABETH A LEWIS D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEWIS
Provider First Name:
ELIZABETH
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
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:
1285740159
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
MID ATLANTIC ANESTHESIA CONSULTANTS PLLC
Provider Second Line Business Mailing Address:
P. O. BOX 711841
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43271-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-346-9400
Provider Business Mailing Address Fax Number:
304-345-7320

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 J D ANDERSON DR
Provider Second Line Business Practice Location Address:
MID ATLANTIC ANESTHESIA CONSULTANTS, PLLC
Provider Business Practice Location Address City Name:
MORGANTOWN
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26505-3494
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-346-9400
Provider Business Practice Location Address Fax Number:
304-345-7320
Provider Enumeration Date:
08/22/2006

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: 207L00000X , with the licence number:  1972 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: DA0096 . This is a "RR MEDICARE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 001757382 . This is a "MSBCBS" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 3003594000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0207026000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 27005299701 . This is a "WORKERS COMP" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 27005299700 . This is a "WORKERS COMP" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 270052997004 . This is a "TRICARE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 9364011 . This is a "MEDICARE GROUP AAP" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: P00142950 . This is a "RR MEDICARE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 20554238700 . This is a "BRICKSTREET GROUP" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 0014706469 . This is a "MSBCBS GROUP" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 1070944 . This is a "BRICKSTREET" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 2022544 . This is a "ALLIANCE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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