MEDICARE: HANNAH 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	363A00000X	Physician Assistant	PA12272	TX

General Provider Information

NPI Number	:	1841775814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HANNAH LEWIS

Provider Business Mailing Address
First Line	:	800 MEDICAL CENTER DR
Second Line	:
City	:	DECATUR
State	:	TX
Zip	:	76234-3843
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 MEDICAL CENTER DR
Second Line	:
City	:	DECATUR
State	:	TX
Zip	:	76234-3843
Country	:	US
Telephone Number	:	940-626-2110
Fax Number	:

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

Provider Enumeration Date	:	09/26/2018
Last Update Date	:	01/22/2020

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