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NPI Code Detail

MEDICARE: AUGUSTINE WARNER LEWIS III

MEDICARE: AUGUSTINE WARNER LEWIS III
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
1207Q00000XFamily Medicine Physician0101019901VA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
7080123285OTHERRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1C05698OTHERVAGROUP PTAN
2204502OTHERANTHEM (BC/BS OF VA)
3254728OTHERMAMSI
45606468OTHERAETNA - LIFE
55606468OTHERAETNA - HMO
6MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
81471267OTHERCIGNA
979134OTHERSOUTHERN HEALTH SERVICES

General Provider Information

NPI Number : 1265469738
Entity Type Code : Individual
Provider Name (Legal Business Name) : AUGUSTINE WARNER LEWIS III
Provider Business Mailing Address
First Line : 7864 RICHMOND TAPPAHANNOCK HWY
Second Line :
City : AYLETT
State : VA
Zip : 23009-3056
Country : US
Telephone Number : 804-746-1677
Fax Number : 804-769-3170
Provider Business Practice Location Address
First Line : 7864 RICHMOND TAPPAHANNOCK HWY
Second Line :
City : AYLETT
State : VA
Zip : 23009-3056
Country : US
Telephone Number : 804-746-1677
Fax Number : 804-769-3170
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2006
Last Update Date : 12/29/2009

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Directions to “ AUGUSTINE WARNER LEWIS III ” Practice Location

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