DAVID W WALLACE (NPI# 1376532168) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376532168 |
| Entity Type | Individual |
| Full Name | DAVID W WALLACE |
| Credential | MD MBA |
| Practice Address |
515 Hospital Dr Suite 1 Shelbyville KY 40065-1640 |
| Mailing Address |
100 E Liberty St Ste 800 Louisville KY 40202-1428 |
| Practice Telephone | 5026333525 |
| Practice Fax Number | 5026338075 |
| Mailing Telephone | (502) 633-3525 |
| Mailing Fax Number | 5026338075 |
| Enumeration Date | 2005-10-14 |
| Last Update Date | 2017-09-14 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 22054 | KY | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| UHC | 0100487 | 01 | |
| KY | RR MEDICARE | P00872496 | 01 |
| KY | ANTHEM | 000000048268 | 01 |
| KY | 64220544 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700327061 | David Wallace | Student in an Organized Health Care Education/Training Program | 24606 Mosquero Ln, Mission Viejo, CA 92691-4913 | 2017-03-19 |
| 1265743595 | David R Wallace Jr. | Radiology | 200 W Arbor Dr # Mc0834, Department of Radiology, San Diego, CA 92102-0834 | 2010-07-01 |
| 1386868487 | David Stuart Wallace | Chiropractor | 2330 Highway 94 South Outer Rd, Saint Charles, MO 63303-8301 | 2007-04-12 |
| 1649343641 | David Michael Wallace | Chiropractor | 112 W Grand Ave, Rainbow City, AL 35906-3233 | 2006-11-16 |
| 1932193604 | David Wallace | Anesthesiology | 738 Golden Pheasant Dr, Draper, UT 84020-8454 | 2005-09-08 |
| 1386646206 | David Allen Wallace | Dentist | 206 S Walker St, Princeton, WV 24740-2747 | 2005-08-11 |
| 1295736809 | David B. Wallace | Radiology | 325 N Highland Ave, Provena Mercy Medical Center, Aurora, IL 60506-3811 | 2005-08-04 |
| 1679576276 | David Alan Wallace | Ophthalmology | 11600 Wilshire Blvd, Ste 200, Los Angeles, CA 90025-1782 | 2005-05-27 |
| 1619596335 | David Alexander Wallace | Student in an Organized Health Care Education/Training Program | 920 Madison Ave Ste 447, Memphis, TN 38103-3438 | 2020-04-13 |
| 1396364402 | David Carter Wallace | Student in an Organized Health Care Education/Training Program | 620 Shadow Ln, Las Vegas, NV 89106-4119 | 2020-04-09 |
| Street Address |
515 HOSPITAL DR SUITE 1 |
| City | SHELBYVILLE |
| State | KY |
| Zip Code | 40065-1640 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487648788 | James R Smith | Family Medicine | 515 Hospital Dr, Ste 1, Shelbyville, KY 40065-1619 | 2005-09-01 |
| 1487911673 | First Urology, Psc | Nurse Practitioner | 515 Hospital Dr, Suite 3, Shelbyville, KY 40065-1619 | 2012-04-12 |
| 1366693905 | Laura Elizabeth Davis | Physician Assistant | 515 Hospital Dr, Suite # 1, Shelbyville, KY 40065-1619 | 2008-10-01 |
| 1780863167 | Amy Michelle Morehead | Nurse Practitioner | 515 Hospital Dr, Suite 1, Shelbyville, KY 40065-1640 | 2007-11-01 |
| 1528057932 | Renee G Ryan | Physician Assistant | 515 Hospital Dr, Suite 1, Shelbyville, KY 40065-1619 | 2005-10-18 |
| 1508855123 | Edward L Sames | Internal Medicine | 515 Hospital Dr, Suite 1, Shelbyville, KY 40065-1640 | 2005-10-17 |
| 1053300681 | Family Physician Associates Psc | Family Medicine | 515 Hospital Dr, Suite 1, Shelbyville, KY 40065-1619 | 2005-10-17 |
| 1548259328 | Jenniffer A Goodlett | Physical Therapist | 515 Hospital Dr, Suite 1, Shelbyville, KY 40065-1619 | 2005-10-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013348242 | Elisa Sykes-brees | Counselor | 250 Alpine Drive, Shelbyville, KY 40065 | 2013-12-13 |
| 1073800512 | Mimi Y. R. Rayburn | Nurse Practitioner | 865 Old Taylorsville Rd, Shelbyville, KY 40065 | 2011-07-05 |
| 1124310677 | Amanda B Dassel | Pharmacist | 1605 Midland Trail, Shelbyville, KY 40065 | 2011-05-03 |
| 1639468812 | Tia M Alton | Pediatrics | 150 Frankfort Rd Ste 101, Shelbyville, KY 40065 | 2011-03-29 |
| 1699073338 | Emily Ann Waits | Dietitian, Registered | 615 11th Street, Shelby County Health Dept., Shelbyville, KY 40065 | 2011-03-04 |
| 1124335401 | Kelli L. Fetter | Occupational Therapist | 1900 Midland Trail, Ste 1 & 2, Shelbyville, KY 40065 | 2010-09-08 |
| 1083939425 | Marilyn Louise Rhoads | Licensed Practical Nurse | 615 Washington Street, Mercy Clinic, Shelbyville, KY 40065 | 2010-03-29 |
| 1154525277 | Dorman Preschool Center | Early Intervention Provider Agency | 719 Burks Branch Road, Shelbyville, KY 40065 | 2007-06-13 |
| 1194946368 | Joanna Sames | Pharmacist | 16 Village Plaza, Shelbyville, KY 40065 | 2007-05-02 |
| 1033298922 | Robyn A Keeling | Dentist | 502 Mount Eden Rd, Shelbyville, KY 40065 | 2006-11-03 |
| Find all providers in zip 40065 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699177956 | Shelbyville Medical Group, Pllc | Family Medicine | 221 Lane Parkway, Shelbyville, TN 37160 | 2014-09-18 |
| 1629314653 | Major Medical Group LLC | Family Medicine | 1626 E State Rd 44, Ste A, Shelbyville, IN 46176-4057 | 2012-12-19 |
| 1275811077 | Matthew Ryan Brock | Family Medicine | 116 Frank Martin Rd, Shelbyville, TN 37160-7192 | 2011-07-27 |
| 1598991853 | Bridgette Loreen Carroll | Family Medicine | 865 Taylorsville Rd, Shelbyville, KY 40065-9124 | 2009-06-01 |
| 1437398492 | Major Multispecialty Associates | Family Medicine | 275 W Bassett Rd Ste 4, Shelbyville, IN 46176-8575 | 2009-02-16 |
| 1194915793 | Joseph H. Rupard, M.d., Ph.d. | Family Medicine | 883 Union St, Shelbyville, TN 37160-2607 | 2007-07-30 |
| 1871791293 | Frank L Jayakody Md PC | Family Medicine | 1701 North Main St, Shelbyville, TN 37160 | 2007-07-06 |
| 1245341403 | Samuel Paul Sells Jr. | Family Medicine | 1701 North Main Street, Suite A, Shelbyville, TN 37160 | 2006-08-31 |
| 1932214798 | Laura Lee Rife | Family Medicine | 1626 E State Road 44, Suite B, Shelbyville, IN 46176-4026 | 2006-08-20 |
| 1447288709 | William J Jackson | Family Medicine | 148 Midland Blvd, Shelbyville, KY 40065-9734 | 2006-06-28 |
| Find all providers in SHELBYVILLE | ||||
| City | SHELBYVILLE |
| Zip Code | 40065 |
Please comment or provide details below to improve the information on DAVID W WALLACE.
| 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.