MEDICARE: JOHN W LEWIS D.O. FAMILY PRACTICE P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	0102201012	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CK5921	OTHER	VA	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	463197	OTHER	VA	ANTHEM
4	7460270	OTHER	VA	AETNA

General Provider Information

NPI Number	:	1316135502
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN W LEWIS D.O. FAMILY PRACTICE P.C.

Provider Business Mailing Address
First Line	:	411 W RIVERSIDE ST
Second Line	:
City	:	COVINGTON
State	:	VA
Zip	:	24426-1273
Country	:	US
Telephone Number	:	540-962-1278
Fax Number	:	540-962-1282

Provider Business Practice Location Address
First Line	:	411 W RIVERSIDE ST
Second Line	:
City	:	COVINGTON
State	:	VA
Zip	:	24426-1273
Country	:	US
Telephone Number	:	540-962-1278
Fax Number	:	540-962-1282

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	DR. JOHN WARREN LEWIS JR.
Credential	:	D.O.
Telephone Number	:	540-962-1278

Provider Enumeration Date	:	10/12/2007
Last Update Date	:	10/18/2012

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