Basic Information
| Provider Information | |||||||||
| NPI: | 1366472615 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SQUIRES | ||||||||
| FirstName: | HERBERT | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 403 HILLCREST DR | ||||||||
| Address2: | SUITE A | ||||||||
| City: | EASLEY | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296401207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8648552737 | ||||||||
| FaxNumber: | 8648552221 | ||||||||
| Practice Location | |||||||||
| Address1: | 403 HILLCREST DR | ||||||||
| Address2: | SUITE A | ||||||||
| City: | EASLEY | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296401207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8648552737 | ||||||||
| FaxNumber: | 8648552221 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2006 | ||||||||
| LastUpdateDate: | 07/24/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 12397 | SC | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 123976 | 05 | SC | MEDICAID | 582296052-562 | 01 | SC | BLUE CROSS | OTHER |