Basic Information
| Provider Information | |||||||||
| NPI: | 1134208523 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEWIS | ||||||||
| FirstName: | GINA | ||||||||
| MiddleName: | |||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1475 | ||||||||
| Address2: | |||||||||
| City: | DES MOINES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503051475 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5156434374 | ||||||||
| FaxNumber: | 5156432784 | ||||||||
| Practice Location | |||||||||
| Address1: | 5900 E UNIVERSITY AVE | ||||||||
| Address2: | |||||||||
| City: | PLEASANT HILL | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503278457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5156432400 | ||||||||
| FaxNumber: | 5156434766 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2006 | ||||||||
| LastUpdateDate: | 02/12/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 20A8870 | CA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 3532 | IA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1932415 | 01 | CA | GREAT WEST | OTHER | 90198225 | 01 | CA | PACIFICARE | OTHER | 2689213 | 01 | CA | UNITED HEALTHCARE | OTHER | 70271 | 01 | IA | WELLMARK BLUE SHIELD | OTHER | 0400165 | 05 | IA | MEDICAID | 20A8870 | 01 | CA | BLUE CROSS | OTHER | 00AX88700 | 05 | CA | MEDICAID | 161241 | 01 | CA | INTERPLAN | OTHER |