Provider Demographics
NPI:1164244042
Name:LIZZIE HEALTH INSTITUTION
Entity type:Organization
Organization Name:LIZZIE HEALTH INSTITUTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED MEDICAL ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:BRITTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:CMA
Authorized Official - Phone:731-313-1023
Mailing Address - Street 1:136 LYNDHURST DR
Mailing Address - Street 2:
Mailing Address - City:LA VERGNE
Mailing Address - State:TN
Mailing Address - Zip Code:37086-3486
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:277 HULL ST
Practice Address - Street 2:
Practice Address - City:DYER
Practice Address - State:TN
Practice Address - Zip Code:38330-2011
Practice Address - Country:US
Practice Address - Phone:731-446-7116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-30
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)