MEDICARE: MRS. BARBARA AIMABLE HARRIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	19193	MD

General Provider Information

NPI Number	:	1558794115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BARBARA AIMABLE HARRIS

Provider Business Mailing Address
First Line	:	9563 BICKNELL SEDGE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78254-2273
Country	:	US
Telephone Number	:	850-380-8452
Fax Number	:

Provider Business Practice Location Address
First Line	:	WILFORD HALL AMBULATORY SURGICAL CENTER
Second Line	:	1100 WILFORD HALL LOOP, BLDG 4554
City	:	JBSA-LACKLAND AFB
State	:	TX
Zip	:	78236-9908
Country	:	US
Telephone Number	:	410-605-7000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2013
Last Update Date	:	10/13/2021

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