MEDICARE: JOHN CHRISTOPHER 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	363AS0400X	Surgical Physician Assistant	A774	SC

General Provider Information

NPI Number	:	1881744555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN CHRISTOPHER LEWIS PA

Provider Business Mailing Address
First Line	:	PO BOX 3239
Second Line	:
City	:	FLORENCE
State	:	SC
Zip	:	29502-3239
Country	:	US
Telephone Number	:	843-777-7120
Fax Number	:	843-777-7102

Provider Business Practice Location Address
First Line	:	3980 HIGHWAY 9 E
Second Line	:	SUITE 200
City	:	LITTLE RIVER
State	:	SC
Zip	:	29566-8163
Country	:	US
Telephone Number	:	843-390-0100
Fax Number	:	843-390-0038

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

Provider Enumeration Date	:	01/12/2007
Last Update Date	:	02/08/2021

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