Active NPI
Mia Lewis
- Dentist
- Marrero, LA
National Provider Identifier
1689358897
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 7612
- Practice address
- 7001 Lapalco Blvd
Marrero, LA 70072-4503 - Phone
- (504) 341-4006
- NPI assigned
- Jun 9, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 7612 | LA | Primary |
Addresses
Primary practice location
7001 Lapalco Blvd
Marrero, LA 70072-4503
Mailing address
PO Box 5414
West Memphis, AR 72303-5414
Phone (870) 636-1344
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in LA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20251104002335 | LA | Order and Referring Only - Dentist | 0749770279 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7612 | LA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1686268800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1723593600000",
"number": "1689358897",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 5414",
"city": "WEST MEMPHIS",
"state": "AR",
"postal_code": "723035414",
"telephone_number": "870-636-1344"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7001 LAPALCO BLVD",
"city": "MARRERO",
"state": "LA",
"postal_code": "700724503",
"telephone_number": "504-341-4006"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEWIS",
"first_name": "MIA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-06-09",
"last_updated": "2024-08-14",
"certification_date": "2024-08-14",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "LA",
"license": "7612",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Marrero, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.