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NPI Code Detail

MEDICARE: MR. JOHN WILLIAM LEWIS JR. LSW

MEDICARE: MR. JOHN WILLIAM LEWIS JR. LSW
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
1104100000XSocial Worker33010629AIN

General Provider Information

NPI Number : 1578217741
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JOHN WILLIAM LEWIS JR. LSW
Provider Business Mailing Address
First Line : 3032 CRESTWELL DR
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46268-8654
Country : US
Telephone Number : 317-698-8837
Fax Number :
Provider Business Practice Location Address
First Line : 7550 S MERIDIAN ST STE A
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46217-2912
Country : US
Telephone Number : 317-992-1919
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/07/2022
Last Update Date : 02/07/2022

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