MEDICARE: MADISON 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	390200000X	Student in an Organized Health Care Education/Training Program
2	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1881351674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADISON LEWIS

Provider Business Mailing Address
First Line	:	116 MILL CREEK XING
Second Line	:
City	:	MADISON
State	:	AL
Zip	:	35758-7200
Country	:	US
Telephone Number	:	256-289-0035
Fax Number	:

Provider Business Practice Location Address
First Line	:	116 MILL CREEK XING
Second Line	:
City	:	MADISON
State	:	AL
Zip	:	35758-7200
Country	:	US
Telephone Number	:	256-289-0035
Fax Number	:

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

Provider Enumeration Date	:	11/29/2021
Last Update Date	:	11/29/2021

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Directions to “ MADISON LEWIS ” Practice Location

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