MEDICARE: SETH R LEWIS MD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	264301-1205	OTHER	UT	STATE LICENSE NUMBER
3	F91544	OTHER	UT	UPIN
4	1851409544	OTHER		INDIVIDUAL NPI
5	000060812	OTHER		PTAN

General Provider Information

NPI Number	:	1205032190
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SETH R LEWIS MD PC

Provider Business Mailing Address
First Line	:	555 E 5300 S STE 7
Second Line	:
City	:	OGDEN
State	:	UT
Zip	:	84405-4509
Country	:	US
Telephone Number	:	801-475-5100
Fax Number	:	801-475-8580

Provider Business Practice Location Address
First Line	:	555 E 5300 S STE 7
Second Line	:
City	:	OGDEN
State	:	UT
Zip	:	84405-4509
Country	:	US
Telephone Number	:	801-475-5100
Fax Number	:	801-475-8580

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	NATALIE HALE
Credential	:
Telephone Number	:	801-475-5100

Provider Enumeration Date	:	06/26/2007
Last Update Date	:	08/10/2021

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Directions to “SETH R LEWIS MD PC ” Practice Location

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