WALLACE UROLOGY INC (NPI# 1316496664) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316496664 |
| Entity Type | Organization |
| Organization Name | WALLACE UROLOGY INC |
| Practice Address |
1325 Eastmoreland Ave Ste 425 Memphis TN 38104-7541 |
| Practice Telephone | 9012723200 |
| Practice Fax Number | 9012783441 |
| Mailing Telephone | 9012723200 |
| Mailing Fax Number | 9012783441 |
| Enumeration Date | 2016-09-28 |
| Last Update Date | 2016-09-28 |
| Authorized Official Name | DR. CHARLES RUSSELL WALLACE JR. (MEDICAL DOCTOR) |
| Authorized Official Telephone | 9012723200 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208800000X | Urology | 015359 | TN | Allopathic & Osteopathic Physicians |
| Street Address |
1325 EASTMORELAND AVE STE 425 |
| City | MEMPHIS |
| State | TN |
| Zip Code | 38104-7541 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558522367 | Charles R. Wallace, Jr., Md | Urology | 1325 Eastmoreland Ave Ste 425, Memphis, TN 38104-7541 | 2008-06-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952900367 | Christy White | Recreation Therapist | 1030 Jefferson Ave (rt117), Memphis, TN 38104 | 2020-10-19 |
| 1821615873 | Altiana Carter | Optometrist | 650 New York St, Memphis, Tn 38104, Memphis, TN 38104 | 2020-06-25 |
| 1952898413 | Family To Family Adult Care Service | Chore Provider | 1331 Union Ave Suite 1028, Mempnis, TN 38104 | 2018-04-19 |
| 1326544800 | Kimberly Vestoria Mcclinton | Nurse Practitioner | 2200 Union Ave 1, Memphis, TN 38104 | 2018-04-03 |
| 1649799339 | Benjamin Duhart Jr. | Pharmacist | 1265 Union Avenue- Methodist University Hospital, Ground Floor Pharmacy Administration, Memphis, TN 38104 | 2017-09-13 |
| 1134644982 | Amy Michelle Wise | Nurse Practitioner | 1325 Eastmoreland Ave Ste 500, Memphis, TN 38104 | 2017-08-13 |
| 1316468572 | Jinger Cathey | Social Worker | 1330 Jefferson Ave, Memphis, TN 38104 | 2017-06-28 |
| 1336669183 | Charma May Kavuncu | Social Worker | 1407 Union Ave Ste 1100, Memphis, TN 38104 | 2017-06-22 |
| 1003345398 | Angelica J Dennis | Nurse Practitioner | 1265 Union, Memphis, TN 38104 | 2017-06-08 |
| 1609302546 | Cheryl Beene | Nurse Practitioner | 1211 Union Ave Ste 475, Memphis, TN 38104 | 2017-05-11 |
| Find all providers in zip 38104 | ||||
| Taxonomy Code | 208800000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Urology |
| A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Urology, 2007. http://www.abu.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Urology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700101441 | Zachary Corr | Urology | 6029 Walnut Grove Rd Ste 300, Memphis, TN 38120 | 2010-04-06 |
| 1558522367 | Charles R. Wallace, Jr., Md | Urology | 1325 Eastmoreland Ave Ste 425, Memphis, TN 38104-7541 | 2008-06-24 |
| 1659389781 | Maurizio Buscarini | Urology | 910 Madison Ave Rm 409, Memphis, TN 38103-3403 | 2006-08-04 |
| 1710902440 | Leslie R Mcgowan | Urology | 6027 Walnut Grove Suite 319, The Urology Group PC, Memphis, TN 38120-2128 | 2006-07-13 |
| 1235164286 | David A Gubin | Urology | 6029 Walnut Grove Rd., Suite 300, Memphis, TN 38120 | 2006-07-11 |
| 1710945860 | Robert Alfred Donato | Urology | 995 S Yates Rd, Suite 1, Memphis, TN 38119-0882 | 2006-05-01 |
| 1902194897 | S K Ganguli Md PC | Urology | 6005 Park Ave, Suite 308, Memphis, TN 38119-5202 | 2011-07-13 |
| 1417272063 | Matthew Jude Mutter | Urology | 880 Madison Ave, Memphis, TN 38103-3409 | 2010-04-06 |
| 1306089206 | Baptist Memorial Medical Group Inc | Urology | 8970 Winchester Rd, Memphis, TN 38125-8231 | 2009-04-08 |
| 1346419751 | William Van Bingham, M.d., P.C. | Urology | 6005 Park Ave, Suite 803, Memphis, TN 38119-5202 | 2008-02-29 |
| Find all providers in MEMPHIS | ||||
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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.