1750464889 NPI number — LEWES FAMILY PRACTICE P.A.

Table of content: (NPI 1750464889)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750464889 NPI number — LEWES FAMILY PRACTICE P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEWES FAMILY PRACTICE P.A.
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:
1750464889
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/11/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 786
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEWES
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19958-0786
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-645-2281
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1305 SAVANNAH RD
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
LEWES
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19958-1514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-645-2281
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BEEBE
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
KIRKLAND
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
302-645-2281

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CA4829 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0745388000 . This is a "AMERIHEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: LV69 . This is a "CAREFIRST BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0000205002 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".




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