Basic Information
| Provider Information | |||||||||
| NPI: | 1992229280 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | J C LEWIS PRIMARY HEALTH CARE CENTER INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 13577 | ||||||||
| Address2: | |||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314160577 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9124958887 | ||||||||
| FaxNumber: | 9122332057 | ||||||||
| Practice Location | |||||||||
| Address1: | 5 MALL ANX | ||||||||
| Address2: | |||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314064738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9127216705 | ||||||||
| FaxNumber: | 9122332057 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2017 | ||||||||
| LastUpdateDate: | 03/30/2021 | ||||||||
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| AuthorizedOfficialLastName: | LOWE | ||||||||
| AuthorizedOfficialFirstName: | GWENDOLYN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 9124958887 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | J C LEWIS PRIMARY HEALTHCARE CENTER, INC | ||||||||
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| NPICertificationDate: | 03/30/2021 | ||||||||
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.