Healthcare Provider Details

I. General information

NPI: 1275531170
Provider Name (Legal Business Name): L.J.LEWIS ENTERPRISES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 01/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 SOUTH ST SE
WARREN OH
44483-5719
US

IV. Provider business mailing address

421 SOUTH ST SE
WARREN OH
44483-5719
US

V. Phone/Fax

Practice location:
  • Phone: 330-369-3600
  • Fax: 330-395-0110
Mailing address:
  • Phone: 330-369-3600
  • Fax: 330-395-0110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number780012
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number780012
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number780012
License Number StateOH

VIII. Authorized Official

Name: MR. JOHN L POPADAK
Title or Position: PRESIDENT
Credential:
Phone: 330-369-3600