Healthcare Provider Details

I. General information

NPI: 1417604091
Provider Name (Legal Business Name): LEWIS LAB SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2022
Last Update Date: 03/07/2022
Certification Date: 03/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4144 WAGON WHEEL DR
MEMPHIS TN
38127-3618
US

IV. Provider business mailing address

4144 WAGON WHEEL DR
MEMPHIS TN
38127-3618
US

V. Phone/Fax

Practice location:
  • Phone: 901-949-6228
  • Fax: 901-592-4212
Mailing address:
  • Phone: 901-949-6228
  • Fax: 901-592-4212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MR. JEREMY LEWIS
Title or Position: OWNER
Credential:
Phone: 901-949-6228