=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306035043
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAMUEL LEWIS MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/18/2007
-----------------------------------------------------
Last Update Date | 02/26/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11335 ALTAMONT DR
-----------------------------------------------------
City | FRISCO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75034-1182
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-729-1650
-----------------------------------------------------
Fax | 214-722-1790
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3245 W MAIN ST SUITE 235-376
-----------------------------------------------------
City | FRISCO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75034-4411
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-729-1650
-----------------------------------------------------
Fax | 214-722-1790
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. SAMUEL LEWIS
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 214-729-1650
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207UN0901X
-----------------------------------------------------
Taxonomy Name | Nuclear Cardiology Physician
-----------------------------------------------------
License Number | E7652
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------