Healthcare Provider Details

I. General information

NPI: 1568616142
Provider Name (Legal Business Name): LEWIS HEALTH INSTITUTE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2008
Last Update Date: 10/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 SW ST. LUCIE WEST BLVD.
PT. ST. LUCIE FL
34986
US

IV. Provider business mailing address

PO BOX 1447
FT. PIERCE FL
34954-1447
US

V. Phone/Fax

Practice location:
  • Phone: 772-398-6200
  • Fax: 772-398-6246
Mailing address:
  • Phone: 772-398-6200
  • Fax: 772-398-6246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberME100426
License Number StateFL

VIII. Authorized Official

Name: DR. YOLANDA V LEWIS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 772-398-6000