| The Lewis Clinic | |
|
430 Magnolia Rd Camden AR 71701-4146 | |
| (870) 836-5709 | |
| (870) 836-5837 |
| Full Name | The Lewis Clinic |
|---|---|
| Speciality | Family Medicine |
| Location | 430 Magnolia Rd, Camden, Arkansas |
| Authorized Official Name and Position | Johnathan Lewis (OWNER) |
| Authorized Official Contact | 8708365709 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Lewis Clinic 430 Magnolia Rd Camden AR 71701-4146 Ph: (870) 836-4709 | The Lewis Clinic 430 Magnolia Rd Camden AR 71701-4146 Ph: (870) 836-5709 |
| NPI Number | 1265047187 |
|---|---|
| Provider Enumeration Date | 09/09/2020 |
| Last Update Date | 09/14/2020 |
| Medicare PECOS PAC ID | 2668891763 |
|---|---|
| Medicare Enrollment ID | O20200923000480 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265047187 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Secondary |
| Provider Name | Johnathan W Lewis |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1699741298 PECOS PAC ID: 7214911627 Enrollment ID: I20040615000200 |
| Provider Name | Brent D Blackburn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548669823 PECOS PAC ID: 2567684400 Enrollment ID: I20141110001953 |
| Provider Name | Randi Leann Beard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366054959 PECOS PAC ID: 7618395864 Enrollment ID: I20200921000681 |
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