Provider Demographics
NPI:1124124250
Name:DANA MARIE LEWIS, D.O., INC
Entity type:Organization
Organization Name:DANA MARIE LEWIS, D.O., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:530-477-9100
Mailing Address - Street 1:10052 ALTA SIERRA DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95949-6886
Mailing Address - Country:US
Mailing Address - Phone:530-477-9100
Mailing Address - Fax:530-477-2033
Practice Address - Street 1:10052 ALTA SIERRA DR
Practice Address - Street 2:SUITE A
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95949-6886
Practice Address - Country:US
Practice Address - Phone:530-477-9100
Practice Address - Fax:530-477-2033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7088208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX70880Medicaid
CA00AX70880Medicaid
CA=========OtherEIN
CAH26201Medicare UPIN