1093169435 NPI number — TRACY LEE LEWIS

Table of content: TRACY LEE LEWIS (NPI 1093169435)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093169435 NPI number — TRACY LEE LEWIS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEWIS
Provider First Name:
TRACY
Provider Middle Name:
LEE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LEWIS
Provider Other First Name:
TRACY
Provider Other Middle Name:
OSBORNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1093169435
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/22/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6000 YOUNGSTOWN-NILES RD.
Provider Second Line Business Mailing Address:
TRUMBULL COUNTY EDUCATIONAL SERVICE CENTER
Provider Business Mailing Address City Name:
NILES
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44446
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-505-2800
Provider Business Mailing Address Fax Number:
330-505-2814

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
905 MILTON BLVD.
Provider Second Line Business Practice Location Address:
NEWTON FALLS SCHOOLS
Provider Business Practice Location Address City Name:
NEWTON FALLS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44444
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-872-0695
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/22/2016

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: 235Z00000X , with the licence number:  SP-4357 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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