Healthcare Provider Details

I. General information

NPI: 1558794115
Provider Name (Legal Business Name): MRS. BARBARA AIMABLE HARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2013
Last Update Date: 10/13/2021
Certification Date: 09/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WILFORD HALL AMBULATORY SURGICAL CENTER 1100 WILFORD HALL LOOP, BLDG 4554
JBSA-LACKLAND AFB TX
78236-9908
US

IV. Provider business mailing address

9563 BICKNELL SEDGE
SAN ANTONIO TX
78254-2273
US

V. Phone/Fax

Practice location:
  • Phone: 410-605-7000
  • Fax:
Mailing address:
  • Phone: 850-380-8452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number19193
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: