Wallace Family Practice Pa in Lehigh Acres - Clinic/center
Wallace Family Practice Pa - NPI 1063548410
Wallace Family Practice Pa is a Clinic/center in Lehigh Acres, Florida. Wallace Family Practice Pa practices all healthcare services and medical treatments related to Clinic/center. The NPI Number for Wallace Family Practice Pa is 1063548410. The last update date is 2010-12-29.
Wallace Family Practice Pa's current location address is 3400 Lee Blvd, Lehigh Acres, Florida. You can contact this provider via phone number 2393692903 and fax number 2393690500. The mailing address for Wallace Family Practice Pa is 3400 Lee Blvd, Lehigh Acres, Florida. To know further, please read the information below!
Provider Profile Detail
| Provider Organization | Wallace Family Practice Pa |
|---|---|
| Address | 3400 Lee Blvd, Lehigh Acres, Florida |
| Phone Number | 2393692903 |
| Fax Number | 2393690500 |
| Sole Proprietor | -- |
| Credentials | -- |
Authorized Official
| Title or Position | PRESIDENT |
|---|---|
| Authorized Official Name | Wallace B. Tasha |
| Credentials | D.O. |
| Telephone Number | 2393692903 |
NPI Number Detail
| NPI Number | 1063548410 |
|---|---|
| Provider Enumeration Date | 2007-02-27 |
| Last Updated Date | 2010-12-29 |
Provider Mailing Address Detail
| Address | 3400 Lee Blvd |
|---|---|
| City | Lehigh Acres |
| State | Florida (FL) |
| Post Code | 339711309 |
| Phone Number | 2393692903 |
| Fax Number | 2393690500 |
Provider's Primary Taxonomy Detail
| Speciality | Clinic/center |
|---|---|
| Taxonomy | 261Q00000X |
| Licence No | OS8622 |
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Definition: A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g |
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Post Comment/ Review Below
What is the Wallace Family Practice Pa's 1063548410?
The Wallace Family Practice Pa's NPI (National Provider Identifier) Number is 1063548410. This unique 10-digit identification number is assigned to health care providers by the Centers for Medicare & Medicaid Services (CMS).
Could you share the physical location details of Wallace Family Practice Pa?
The Wallace Family Practice Pa is situated at 3400 Lee Blvd, in the city of Lehigh Acres, state of FL, with the zip code 339711309.
What is Wallace Family Practice Pa's specialized area of practice, and what is the corresponding taxonomy classification code for this field?
The Wallace Family Practice Pa's specialized field of practice is Clinic/center, and the corresponding taxonomy code that categorizes this area of specialization is 261Q00000X.
On what date did the Wallace Family Practice Pa receive its 1063548410 assignment from the Centers for Medicare & Medicaid Services?
The Wallace Family Practice Pa was assigned its 1063548410 by the Centers for Medicare & Medicaid Services on 2007-02-27.
When was the information related to Wallace Family Practice Pa most recently updated or refreshed?
The details pertaining to the Wallace Family Practice Pa, including its address, specialty, and other relevant information, were last updated or refreshed on 2010-12-29.