MEDICARE: LEWIS-BRYANT TRANSPORTATION

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	347C00000X	Private Vehicle
2	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1568641488
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEWIS-BRYANT TRANSPORTATION

Provider Business Mailing Address
First Line	:	11825 LONGWOOD GARDEN WAY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77047-4435
Country	:	US
Telephone Number	:	832-207-2363
Fax Number	:	713-862-4913

Provider Business Practice Location Address
First Line	:	11825 LONGWOOD GARDEN WAY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77047-4435
Country	:	US
Telephone Number	:	832-207-2363
Fax Number	:	713-862-4913

Authorized Official
Title or Position	:	PRESIDENT/PROGRAM MANAGER
Name	:	MRS. LYDIA M LEWIS
Credential	:
Telephone Number	:	832-207-2363

Provider Enumeration Date	:	10/27/2007
Last Update Date	:	10/27/2007

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