Provider Demographics
NPI:1316135502
Name:JOHN W LEWIS D.O. FAMILY PRACTICE P.C.
Entity type:Organization
Organization Name:JOHN W LEWIS D.O. FAMILY PRACTICE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WARREN
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:540-962-1278
Mailing Address - Street 1:411 W RIVERSIDE ST
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:24426-1273
Mailing Address - Country:US
Mailing Address - Phone:540-962-1278
Mailing Address - Fax:540-962-1282
Practice Address - Street 1:411 W RIVERSIDE ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:VA
Practice Address - Zip Code:24426-1273
Practice Address - Country:US
Practice Address - Phone:540-962-1278
Practice Address - Fax:540-962-1282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102201012207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VACK5921OtherMEDICARE RAILROAD
VA005645344Medicaid
VA463197OtherANTHEM
VA7460270OtherAETNA
VA005645344Medicaid
VACK5921OtherMEDICARE RAILROAD
VA7460270OtherAETNA