| J.c. Lewis Primary Healthcare Center, Inc | |
|
5 Mall Anx Savannah GA 31406-4738 | |
| (912) 721-6701 | |
| (912) 495-8881 |
| Full Name | J.c. Lewis Primary Healthcare Center, Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 5 Mall Anx, Savannah, Georgia |
| Authorized Official Name and Position | Rena Douse (CEO) |
| Authorized Official Contact | 9127216701 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| J.c. Lewis Primary Healthcare Center, Inc 5 Mall Anx Savannah GA 31406-4738 Ph: (912) 721-6705 | J.c. Lewis Primary Healthcare Center, Inc 5 Mall Anx Savannah GA 31406-4738 Ph: (912) 721-6701 |
| NPI Number | 1922301472 |
|---|---|
| Provider Enumeration Date | 12/06/2010 |
| Last Update Date | 09/06/2024 |
| Medicare PECOS PAC ID | 8426203225 |
|---|---|
| Medicare Enrollment ID | O20130228000232 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922301472 | NPI | - | NPPES |
| 003110256A | Medicaid | GA | |
| 003122855A | Medicaid | GA | |
| 003135130A | Medicaid | GA | |
| 003104809A | Medicaid | GA | |
| 003156658A | Medicaid | GA | |
| 003122845A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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