1720180557 NPI number — BARBARA SQUIRES

Table of content: BARBARA SQUIRES (NPI 1720180557)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720180557 NPI number — BARBARA SQUIRES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SQUIRES
Provider First Name:
BARBARA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720180557
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PUGET SOUND HEALTH CARE SYSTEM
Provider Second Line Business Mailing Address:
AMERICAN LAKE BLIND REHABILITATION CENTER, 112BRC/A
Provider Business Mailing Address City Name:
TACOMA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98493-5000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-583-1220
Provider Business Mailing Address Fax Number:
253-589-4081

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PUGET SOUND HEALTH CARE SYSTEM
Provider Second Line Business Practice Location Address:
AMERICAN LAKE BLIND REHABILITATION CENTER, 112BRC/A
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98493-5000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-583-1220
Provider Business Practice Location Address Fax Number:
253-589-4081
Provider Enumeration Date:
09/02/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2255R0406X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)