Organization
KENNETH C. LEWIS MD,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBBIE JOHNS (CREDENTIALER)
(970) 254-1686
Entity
Organization
Contact information
Practice address
201 W PARK DR, GRAND JUNCTION, CO 81505-1469
(509) 591-0070
Mailing address
8524 W GAGE BLVD # 319, KENNEWICK, WA 99336-8241
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
—
—
261QP3300X
Pain Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1092681
—
CO
Enumeration date
06/30/2022
Last updated
06/30/2022
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