1285918433 NPI number — CHRISTA M LEWIS DO

Table of content: CHRISTA M LEWIS DO (NPI 1285918433)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285918433 NPI number — CHRISTA M LEWIS DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEWIS
Provider First Name:
CHRISTA
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1285918433
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/14/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5501 W BETHEL AVE
Provider Second Line Business Mailing Address:
RCS PROVIDER ENROLLMENT
Provider Business Mailing Address City Name:
MUNCIE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47304-8513
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-286-3900
Provider Business Mailing Address Fax Number:
762-286-3915

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
INDIANA UNIVERSITY HEALTH BALL MEMORIAL PHYSICIANS, INC
Provider Second Line Business Practice Location Address:
5501 W BETHEL AVE
Provider Business Practice Location Address City Name:
MUNCIE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47304-8513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-286-3900
Provider Business Practice Location Address Fax Number:
765-286-3915
Provider Enumeration Date:
10/06/2011

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: 207V00000X , with the licence number:  02006340A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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