=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487088928
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRUSTED COMPASSIONATE PHYSICIAN
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2013
-----------------------------------------------------
Last Update Date | 08/31/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5205 S MASON RD SUITE 210 PMB M-2
-----------------------------------------------------
City | KATY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77450-7138
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-687-0282
-----------------------------------------------------
Fax | 832-803-4792
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5205 S MASON RD SUITE 210 PMB M-2
-----------------------------------------------------
City | KATY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77450-7138
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-687-0282
-----------------------------------------------------
Fax | 832-803-4792
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. JIMMIE EARL LEWIS JR.
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 832-687-0282
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------