MEDICARE: SAVANNAH MARIE LEWIS PA

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	363AM0700X	Medical Physician Assistant	PA3693	KY
2	363AS0400X	Surgical Physician Assistant	PA3693	KY
3	363A00000X	Physician Assistant	PA3693	KY

General Provider Information

NPI Number	:	1518764430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAVANNAH MARIE LEWIS PA

Provider Business Mailing Address
First Line	:	227 ABBEY RD
Second Line	:
City	:	VERSAILLES
State	:	KY
Zip	:	40383-8063
Country	:	US
Telephone Number	:	256-617-2460
Fax Number	:

Provider Business Practice Location Address
First Line	:	740 S LIMESTONE
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40536-0284
Country	:	US
Telephone Number	:	859-257-3253
Fax Number	:	859-323-1203

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

Provider Enumeration Date	:	02/27/2025
Last Update Date	:	02/04/2026

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