Provider Demographics
NPI:1437333218
Name:INEZ M BEAUPRE LEWIS
Entity type:Organization
Organization Name:INEZ M BEAUPRE LEWIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:INEZ
Authorized Official - Middle Name:M
Authorized Official - Last Name:BEAUPRE LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-864-1842
Mailing Address - Street 1:88 EDMUNDO RD
Mailing Address - Street 2:
Mailing Address - City:BELEN
Mailing Address - State:NM
Mailing Address - Zip Code:87002-7700
Mailing Address - Country:US
Mailing Address - Phone:505-864-1842
Mailing Address - Fax:
Practice Address - Street 1:88 EDMUNDO RD
Practice Address - Street 2:
Practice Address - City:BELEN
Practice Address - State:NM
Practice Address - Zip Code:87002-7700
Practice Address - Country:US
Practice Address - Phone:505-864-1842
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-28
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000T4331Medicaid
NM0771100001Medicare NSC
NM0771100001Medicare PIN