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General NPI Number Information
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NPI Number | 1316135502
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Entity Type | Organization
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Legal Business Name | JOHN W LEWIS D.O. FAMILY PRACTICE P.C.
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Dates
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Enumeration Date | 10/12/2007
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Last Update Date | 10/18/2012
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Provider Practice Location Address
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Address Line | 411 W RIVERSIDE ST
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City | COVINGTON
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State | VA
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Zip | 24426-1273
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Country | US
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Telephone | 540-962-1278
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Fax | 540-962-1282
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Provider Business Mailing Address
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Address Line | 411 W RIVERSIDE ST
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City | COVINGTON
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State | VA
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Zip | 24426-1273
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Country | US
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Telephone | 540-962-1278
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Fax | 540-962-1282
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. JOHN WARREN LEWIS JR.
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Credential | D.O.
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Telephone | 540-962-1278
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0102201012
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License Number State | VA
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