Basic Information
| Provider Information | |||||||||
| NPI: | 1871586917 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SQUIRES | ||||||||
| FirstName: | ANNE | ||||||||
| MiddleName: | CHARLOTTE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9 | ||||||||
| Address2: | |||||||||
| City: | KINGSPORT | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376620009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4238572066 | ||||||||
| FaxNumber: | 4238572070 | ||||||||
| Practice Location | |||||||||
| Address1: | 227 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | ABINGDON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 242102715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2766763870 | ||||||||
| FaxNumber: | 2766288927 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2005 | ||||||||
| LastUpdateDate: | 08/13/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 0101223782 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 47033 | TN | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 47033 | TN | N | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 010200661 | 05 | VA | MEDICAID | 202760 | 01 | VA | BLACK LUNG | OTHER | 0385921 | 01 | VA | UMWA | OTHER | 182872 | 01 | VA | ANTHEM | OTHER | 320218 | 01 | VA | SOUTHERN HEALTH | OTHER |