1780037614 NPI number — J C LEWIS PRIMARY HEALTH CARE CENTER INC

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 1780037614 NPI number — J C LEWIS PRIMARY HEALTH CARE CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
J C LEWIS PRIMARY HEALTH CARE CENTER INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1780037614
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 13577
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAVANNAH
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31416-0577
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-495-8887
Provider Business Mailing Address Fax Number:
912-495-8881

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2414 BULL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAVANNAH
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31401-9113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-495-8887
Provider Business Practice Location Address Fax Number:
912-495-8881
Provider Enumeration Date:
07/15/2016

Additional Information

Authorized Official

Authorized Official Last Name:
LOWE
Authorized Official First Name:
GWENDOLYN
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
912-721-6705

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 003122855A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 202G701304 . This is a "MEDICARE PART B" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 111979 . This is a "MEDICARE PART A" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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