MEDICARE: BARBARA SIMONS PA-C

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	261QP2300X	Primary Care Clinic/Center	PA10005078	WA

General Provider Information

NPI Number	:	1538503040
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BARBARA SIMONS PA-C

Provider Business Mailing Address
First Line	:	PO BOX 543
Second Line	:
City	:	LANGLEY
State	:	WA
Zip	:	98260-0543
Country	:	US
Telephone Number	:	360-331-6535
Fax Number	:	360-331-6545

Provider Business Practice Location Address
First Line	:	1660 LAYTON RD
Second Line	:
City	:	FREELAND
State	:	WA
Zip	:	98249-9456
Country	:	US
Telephone Number	:	360-331-6535
Fax Number	:	360-331-6545

Authorized Official
Title or Position	:	CO-OWNER/OFFICE MANAGER
Name	:	CHRISTINA CARPENTER
Credential	:
Telephone Number	:	360-331-6535

Provider Enumeration Date	:	04/26/2013
Last Update Date	:	04/26/2013

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