MEDICARE: JAMES LEE LEWIS

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	175T00000X	Peer Specialist	APS.002568	OH

General Provider Information

NPI Number	:	1497534416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES LEE LEWIS

Provider Business Mailing Address
First Line	:	7030 N MAIN ST
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45415-2557
Country	:	US
Telephone Number	:	937-977-2928
Fax Number	:

Provider Business Practice Location Address
First Line	:	7030 N MAIN ST
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45415-2557
Country	:	US
Telephone Number	:	937-977-2928
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2023
Last Update Date	:	09/28/2023

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