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NPI Code Detail

MEDICARE: LINDA J LEWIS P.A.-C.

MEDICARE: LINDA J LEWIS P.A.-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
1363A00000XPhysician Assistant001026IA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
153904OTHERIAMEDICARE NON-BILLING NUMBER

General Provider Information

NPI Number : 1336144054
Entity Type Code : Individual
Provider Name (Legal Business Name) : LINDA J LEWIS P.A.-C.
Provider Business Mailing Address
First Line : 300 SIOUX VALLEY DR
Second Line :
City : CHEROKEE
State : IA
Zip : 51012-1205
Country : US
Telephone Number : 712-225-6265
Fax Number : 712-225-6800
Provider Business Practice Location Address
First Line : 300 SIOUX VALLEY DR
Second Line :
City : CHEROKEE
State : IA
Zip : 51012-1205
Country : US
Telephone Number : 712-225-6265
Fax Number : 712-225-6800
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/17/2005
Last Update Date : 12/01/2009

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