CHARLES WALLER (NPI# 1306841341) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306841341 |
| Entity Type | Individual |
| Full Name | CHARLES WALLER |
| Credential | MD |
| Practice Address |
218 Bass Ln Benton KY 42025-5824 |
| Practice Telephone | 2705563239 |
| Practice Fax Number | 2703545865 |
| Mailing Telephone | 2705563239 |
| Mailing Fax Number | 2703545865 |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2017-02-01 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207P00000X | Emergency Medicine | 29738 | KY | Allopathic & Osteopathic Physicians |
| Y | 208D00000X | General Practice | 29738 | KY | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KY | 64297385 | 05 | |
| TN | 4047217 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861528929 | Charles Milton Waller | Dentist | 272 Blue Haven Beach Rd, Camdenton, MO 65020-2123 | 2007-02-25 |
| 1760455265 | Charles F. Waller | Nurse Anesthetist, Certified Registered | 321 N Bailey Ave, Fort Worth, TX 76107-1001 | 2006-02-07 |
| 1659866556 | Charles Cutez Waller | Counselor | 1695 Main St, Springfield, MA 01103-1348 | 2018-06-25 |
| Street Address |
218 BASS LN |
| City | BENTON |
| State | KY |
| Zip Code | 42025-5824 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073862843 | Elisha Dougherty | Pharmacist | 1004 Big Bear Hwy, Benton, KY 42025 | 2012-09-07 |
| 1730310285 | Benton Chiropractic, Pllc | Chiropractor | 141 Commerce Blvd, Benton, KY 42025 | 2009-07-31 |
| 1689813594 | Murray Calloway County Public Hospital | Internal Medicine | 543 Powell St, Benton, KY 42025 | 2009-02-17 |
| 1912159864 | William J Barabas | Physical Therapist | 244 Us Hwy 68 East, Benton, KY 42025 | 2008-10-22 |
| 1447419031 | Mary Jane Darnell | Occupational Therapy Assistant | 2607 Main Street, Benton, KY 42025 | 2008-06-09 |
| 1710176540 | Karen Diane Reed | Counselor | 198 Old Symsonia Road, Suite 107, Benton, KY 42025 | 2007-10-17 |
| 1255475794 | Community Alternatives Kentucky, Inc. | Home Health | 402 Caky Drive, Benton, KY 42025 | 2007-02-17 |
| 1477605988 | Marshall County Medical Associates | Family Medicine | 145 Vine Street, Benton, KY 42025 | 2007-01-17 |
| 1376604256 | Marshall County Assn. for Exceptional Children and Adults, Inc | Day Training, Developmentally Disabled Services | 198 Old Symsonia Road, Benton, KY 42025 | 2006-12-13 |
| 1023111929 | Benton Health Care, LLC | Nurse Practitioner | 414 East 12th Street, Benton, KY 42025 | 2006-09-06 |
| Find all providers in zip 42025 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982811543 | Kirk Medical Clinic | General Practice | 1102 West South St Suite B, Benton, AR 72015 | 2007-05-16 |
| 1033507439 | Epoch Health- Benton, Pllc. | General Practice | 5 Medical Park Dr, Benton, AR 72015-3729 | 2015-01-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
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| 1689214454 | Superior Healthcare Pllc | General Practice | 7560 Us Highway 42 Ste B, Florence, KY 41042-1908 | 2020-01-09 |
| 1144876814 | You Only Live Once Medical | General Practice | 821 Ulrich Ave, Louisville, KY 40219-1844 | 2019-08-17 |
| 1760979124 | Healthy Living Primary Care | General Practice | 4400 Breckenridge Ln Ste 147, Louisville, KY 40218 | 2018-04-20 |
| 1649775586 | Landmark Medical of Kentucky, Psc | General Practice | 113 Glenn Pl Unit 100, Lexington, KY 40505-3518 | 2018-03-23 |
| 1639603145 | Charita Weathers | General Practice | 401 East Chestnut, Ste 610, Louisville, KY 40202 | 2017-04-12 |
| 1881146033 | Alliance Health Care, LLC | General Practice | 1710 D State Route 121 North, Murray, KY 42071 | 2016-11-03 |
| 1528519113 | A New Journey | General Practice | 4100 Cadillac Ct, Louisville, KY 40213-1591 | 2016-10-18 |
| 1013381441 | Veloz Medical Services Corp | General Practice | 6911 Shepherdsville Rd, Louisville, KY 40219-2211 | 2015-11-23 |
| 1407229545 | Fern Medical and Rehab Corp | General Practice | 5520 Fern Valley Rd, 107, Louisville, KY 40228-1087 | 2015-11-12 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.