MEDICARE: MR. LEWIS FREDERICK SCHEICK IDMT

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	1710I1003X	Independent Duty Medical Technicians

General Provider Information

NPI Number	:	1598909541
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LEWIS FREDERICK SCHEICK IDMT

Provider Business Mailing Address
First Line	:	1503 E PARK AVE
Second Line	:	APT. R-4
City	:	VALDOSTA
State	:	GA
Zip	:	31602-5300
Country	:	US
Telephone Number	:	269-589-7212
Fax Number	:

Provider Business Practice Location Address
First Line	:	23 MDG
Second Line	:
City	:	MOODY A F B
State	:	GA
Zip	:	31699-0001
Country	:	US
Telephone Number	:	229-257-1110
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/21/2009
Last Update Date	:	04/21/2009

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