| A Ray Lewis, DO, PLLC | |
|
4732 E Lancaster Ave Ste A Fort Worth TX 76103-3836 | |
| (817) 413-0943 | |
| (817) 413-0300 |
| Full Name | A Ray Lewis, DO, PLLC |
|---|---|
| Speciality | Family Medicine |
| Location | 4732 E Lancaster Ave Ste A, Fort Worth, Texas |
| Authorized Official Name and Position | Adolphus Ray Lewis (OWNER/PHYSICIAN) |
| Authorized Official Contact | 8174130943 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| A Ray Lewis, DO, PLLC 4732 E Lancaster Ave Ste A Fort Worth TX 76103-3836 Ph: (817) 413-0943 | A Ray Lewis, DO, PLLC 4732 E Lancaster Ave Ste A Fort Worth TX 76103-3836 Ph: (817) 413-0943 |
| NPI Number | 1053643130 |
|---|---|
| Provider Enumeration Date | 02/01/2010 |
| Last Update Date | 05/26/2015 |
| Medicare PECOS PAC ID | 1658405865 |
|---|---|
| Medicare Enrollment ID | O20100810000492 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053643130 | NPI | - | NPPES |
| 2166936-01 | Medicaid | TX | |
| 2166985-01 | Medicaid | TX | |
| 0068TD | Other | TX | BLUE CROSS BLUE SHIELD |
| DQ6866 | Other | TX | PALMETTO GBA RAILROAD MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
| Provider Name | Adolphus Ray Lewis |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1265403497 PECOS PAC ID: 4880505403 Enrollment ID: I20041116000102 |
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