Individual
ALBERT W LEWIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1305 ASH ST, BRIDGEPORT, IL 62417-1707
(618) 945-5858
(618) 945-5313
Mailing address
1305 ASH ST, P O BOX 102, BRIDGEPORT, IL 62417-1707
(618) 945-5858
(618) 945-5313
Taxonomy
Speciality
Code
Description
License number
State
341600000X
Ambulance
Primary
5 5232
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
371386411001
—
IL
Enumeration date
10/24/2006
Last updated
07/09/2007
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