Healthcare Provider Details

I. General information

NPI: 1023237021
Provider Name (Legal Business Name): SMITH MOUNTAIN LAKE FAMILY PRACTICE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 05/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 WESTWIND RD
MONETA VA
24121-3726
US

IV. Provider business mailing address

70 WESTWIND RD
MONETA VA
24121-3726
US

V. Phone/Fax

Practice location:
  • Phone: 540-721-7333
  • Fax: 540-721-4971
Mailing address:
  • Phone: 540-721-7333
  • Fax: 540-721-4971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateVA

VIII. Authorized Official

Name: DR. STEVEN T LEWIS
Title or Position: PRESIDENT
Credential: MD
Phone: 540-721-7333