Individual
DR. MARY BETH LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
555 E CHEVES ST, RADIOLOGY DEPARTMENT, FLORENCE, SC 29506-2617
(843) 669-5162
(843) 667-4573
Mailing address
1303 AZALEA CT, STE C, MYRTLE BEACH, SC 29577-5765
(843) 692-0570
(843) 497-9566
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
26702
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
067F4
BCBS OF NC
NC
01
—
154758900
US DEPT OF LABOR
SC
05
—
267026
—
SC
01
—
570525838
STANDARD TAX ID
SC
01
—
890067F4
NC MEDICAID
NC
01
—
D4050
MEDCOST
SC
01
—
P00116458
RAILROAD MEDICARE
SC
Enumeration date
09/28/2005
Last updated
09/13/2016
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