Provider Demographics
NPI:1477592426
Name:LISA WHIMS-SQUIRES, D.O., PA
Entity Type:Organization
Organization Name:LISA WHIMS-SQUIRES, D.O., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:P.A.
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:WHIMS-SQUIRES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:727-466-9847
Mailing Address - Street 1:2840 W BAY DR
Mailing Address - Street 2:SUITE 273
Mailing Address - City:BELLEAIR BLUFFS
Mailing Address - State:FL
Mailing Address - Zip Code:33770-2620
Mailing Address - Country:US
Mailing Address - Phone:727-466-9847
Mailing Address - Fax:727-466-0346
Practice Address - Street 1:1305 S FORT HARRISON AVE
Practice Address - Street 2:BLDG. G
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3301
Practice Address - Country:US
Practice Address - Phone:727-466-9847
Practice Address - Fax:727-466-0346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-05
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS6918207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110241957OtherRRMEDICARE
FLUNITED HEALTHOther4885700
FL259527OtherAVMED
FLFIRST HEALTHOther1745733
FL256024100Medicaid
FL3617741OtherCIGNA
FLAMERIGROUPOther223693
FL2799257OtherAETNA
FL44392OtherBC
FLUNITED HEALTHOther4885700
FLUNITED HEALTHOther4885700
FLK3824Medicare PIN