Basic Information
| Provider Information | |||||||||
| NPI: | 1588188841 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | J C LEWIS PRIMARY HEALTH CARE CENTER INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1508 | ||||||||
| Address2: | |||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314021508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9124958887 | ||||||||
| FaxNumber: | 9124958881 | ||||||||
| Practice Location | |||||||||
| Address1: | 1410 RICHARDS ST | ||||||||
| Address2: | |||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314152038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9124958887 | ||||||||
| FaxNumber: | 9124958881 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2017 | ||||||||
| LastUpdateDate: | 07/28/2017 | ||||||||
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| AuthorizedOfficialLastName: | GAFFNEY | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9127216701 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | J C LEWIS PRIMARY HEALTH CARE CENTER INC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.