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General NPI Number Information
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NPI Number | 1912639642
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Entity Type | Organization
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Legal Business Name | KENNETH C. LEWIS MD,LLC
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Dates
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Enumeration Date | 06/30/2022
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Last Update Date | 06/30/2022
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Provider Practice Location Address
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Address Line | 201 W PARK DR
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City | GRAND JUNCTION
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State | CO
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Zip | 81505-1469
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Country | US
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Telephone | 509-591-0070
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Fax |
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Provider Business Mailing Address
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Address Line | 8524 W GAGE BLVD # 319
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City | KENNEWICK
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State | WA
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Zip | 99336-8241
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CREDENTIALER
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Name | DEBBIE JOHNS
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Credential |
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Telephone | 970-254-1686
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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