=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134208523
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GINA LEWIS D.O.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/04/2006
-----------------------------------------------------
Last Update Date | 02/12/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5900 E UNIVERSITY AVE
-----------------------------------------------------
City | PLEASANT HILL
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50327-8457
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-643-2400
-----------------------------------------------------
Fax | 515-643-4766
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1475
-----------------------------------------------------
City | DES MOINES
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50305-1475
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-643-4374
-----------------------------------------------------
Fax | 515-643-2784
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 20A8870
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 3532
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------