Healthcare Provider Details

I. General information

NPI: 1801935317
Provider Name (Legal Business Name): GEORGE M LEWIS HEALTH SERVICES TECH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 COMMERCIAL ST. USCG ISC BOSTON
BOSTON MA
02109
US

IV. Provider business mailing address

73 WOODLAND ST
HOLYOKE MA
01040
US

V. Phone/Fax

Practice location:
  • Phone: 617-223-3121
  • Fax:
Mailing address:
  • Phone: 413-636-1752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: