Provider Demographics
NPI:1164039087
Name:LEWIS, ELIZABETH CHRISTINE
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:CHRISTINE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 BRIDGEPORT TRL
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44143-1465
Mailing Address - Country:US
Mailing Address - Phone:216-212-2000
Mailing Address - Fax:216-797-9919
Practice Address - Street 1:315 BRIDGEPORT TRL
Practice Address - Street 2:
Practice Address - City:RICHMOND HTS
Practice Address - State:OH
Practice Address - Zip Code:44143-1465
Practice Address - Country:US
Practice Address - Phone:216-212-2000
Practice Address - Fax:216-797-9919
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-24
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRK689193343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)