Active NPI
Albert W Lewis
- Ambulance
- Bridgeport, IL
National Provider Identifier
1871677005
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ambulance
- License
- 5 5232
- Practice address
- 1305 Ash St
Bridgeport, IL 62417-1707 - Phone
- (618) 945-5858
- Fax
- (618) 945-5313
- NPI assigned
- Oct 24, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Ambulance | 341600000X | 5 5232 | IL | Primary |
Addresses
Primary practice location
1305 Ash St
Bridgeport, IL 62417-1707
Mailing address
1305 Ash St
P O Box 102
Bridgeport, IL 62417-1707
Phone (618) 945-5858
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 371386411001 | Medicaid | IL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5 5232 | IL | MD | Ambulance |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161648000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1871677005",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1305 ASH ST",
"address_2": "P O BOX 102",
"city": "BRIDGEPORT",
"state": "IL",
"postal_code": "624171707",
"telephone_number": "618-945-5858",
"fax_number": "618-945-5313"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1305 ASH ST",
"city": "BRIDGEPORT",
"state": "IL",
"postal_code": "624171707",
"telephone_number": "618-945-5858",
"fax_number": "618-945-5313"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEWIS",
"first_name": "ALBERT",
"middle_name": "W",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-24",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "341600000X",
"taxonomy_group": "",
"desc": "Ambulance",
"state": "IL",
"license": "5 5232",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "371386411001",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bridgeport, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.