1831291434 NPI number — MR. RON LEWIS CSW

Table of content: MR. RON LEWIS CSW (NPI 1831291434)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831291434 NPI number — MR. RON LEWIS CSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEWIS
Provider First Name:
RON
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
CSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LEWIS
Provider Other First Name:
RON
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1831291434
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/18/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1811 BETHLEHEM PIKE
Provider Second Line Business Mailing Address:
STE214
Provider Business Mailing Address City Name:
FLOURTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19031-1111
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-643-0200
Provider Business Mailing Address Fax Number:
215-643-9844

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1811 BETHLEHEM PIKE
Provider Second Line Business Practice Location Address:
STE214
Provider Business Practice Location Address City Name:
FLOURTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19031-1111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-643-0200
Provider Business Practice Location Address Fax Number:
215-643-9844
Provider Enumeration Date:
09/02/2006

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: 1041C0700X , with the licence number:  CW013450 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0227455000 . This is a "PERSONAL CHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 176363000 . This is a "MAGELLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0072708210002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5253586 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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