Provider Demographics
NPI:1447274857
Name:LEWIS, JAMES STUART (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:STUART
Last Name:LEWIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1460
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:WV
Mailing Address - Zip Code:25813-1460
Mailing Address - Country:US
Mailing Address - Phone:304-763-3255
Mailing Address - Fax:304-763-3255
Practice Address - Street 1:200 VETERANS AVE
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-6444
Practice Address - Country:US
Practice Address - Phone:304-763-3255
Practice Address - Fax:304-763-3255
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV13546207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0084660000Medicaid
WV000477603OtherMT.STATE BCBS
WV3001543OtherBWC
TN4401035Medicaid
KYP00274410OtherRR-MEDICARE
KYA72358Medicare UPIN
WV0084660000Medicaid