MR. JOHN DAVID WALLACE (NPI# 1487909511) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1487909511 |
| Entity Type | Individual |
| Full Name | MR. JOHN DAVID WALLACE |
| Credential | PA-C |
| Practice Address |
6135 Cressy St Indian River MI 49749-5151 |
| Practice Telephone | 2312388908 |
| Practice Fax Number | 2312384419 |
| Mailing Telephone | 2312388908 |
| Mailing Fax Number | 2312384419 |
| Enumeration Date | 2012-07-15 |
| Last Update Date | 2019-02-26 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 5601006422 | MI | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023508868 | John E Wallace | Physical Therapist | 1060 Nimitzview Dr Ste 205, Cincinnati, OH 45230-4351 | 2018-05-17 |
| 1679900161 | John D Wallace | Counselor | 1455 Nw 53rd St Apt 222, Miami, FL 33142 | 2013-09-30 |
| 1437590973 | John Burton Wallace V | Social Worker | 141 S 5th St Ofc East, Brooklyn, NY 11211 | 2013-07-12 |
| 1346517307 | John Widtsoe Wallace | Specialist | 1091 Southport Dr, Medina, OH 44256-3019 | 2011-11-18 |
| 1225292634 | John Wallace | Anesthesiology | 3420 S Mercy Rd Ste 200, Gilbert, AZ 85297-0423 | 2008-07-15 |
| 1629241070 | John Dean Wallace Jr. | Dentist | 9913 Mission Gorge Rd Unit 1, Santee, CA 92071-3843 | 2008-04-08 |
| 1275663916 | John Robert Wallace | Physical Therapist | 103 W Woodhill Dr, Suite A, Nags Head, NC 27959 | 2007-03-06 |
| 1346379161 | John G Wallace | Psychiatry & Neurology | 17515 N Park Pl N, Shoreline, WA 98133-4803 | 2007-03-05 |
| 1841359775 | John Thomas Wallace | Chiropractor | 3314 Us Highway 431, Albertville, AL 35950 | 2006-12-06 |
| 1316038839 | John Kline Wallace | Dentist | 2501 Princess Anne St, Fredericksburg, VA 22401-3333 | 2006-09-28 |
| Street Address |
6135 CRESSY ST |
| City | INDIAN RIVER |
| State | MI |
| Zip Code | 49749-5151 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609800119 | Robin L Batchelor | Physician Assistant | 6135 Cressy St, Indian River, MI 49749 | 2006-07-10 |
| 1487015798 | Donna Appold | Social Worker | 6135 Cressy St, Indian River, MI 49749-5151 | 2016-03-14 |
| 1831567643 | Alcona Citizens for Health, Inc | Family Medicine | 6135 Cressy St, Indian River, MI 49749 | 2015-09-10 |
| 1114288735 | Northern Michigan Regional Hospital | Clinic/Center | 6135 Cressy St, Post Office Box 548, Indian River, MI 49749-5151 | 2012-05-30 |
| 1639196199 | Community Memorial Hospital | Family Medicine | 6135 Cressy St, Indian River, MI 49749 | 2006-07-17 |
| 1881628253 | John K Everett | Family Medicine | 6135 Cressy St, Indian River, MI 49749 | 2006-07-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518497353 | Kane Rx Inc | Pharmacy | 3944 South Straits Hwy, Indian River, MI 49749 | 2017-06-14 |
| 1598146516 | Sarah Ellen Stearns | Nurse Practitioner | 3860 S Straits Highway, Indian River, MI 49749 | 2015-06-16 |
| 1750781688 | Katheleen Joan Hart | Counselor | 3948 S. Straits Hwy, South Building, Suite 1, Indian River, MI 49749 | 2014-08-28 |
| 1467863993 | Tom Zoyiopoulos | Pharmacist | 1201 Lears, Indian River, MI 49749 | 2014-05-19 |
| 1750533246 | Xcel Physical Therapy, Plc | Occupational Therapist | 351 S Straits Hwy, Indian River, MI 49749 | 2008-10-16 |
| 1407904436 | Jennifer Ann Andrew I | Specialist/Technologist | 3805 S. Sraits Hwy., Indian River, MI 49749 | 2007-01-08 |
| 1952321390 | Douglas A Furman | Family Medicine | 7037 West M-68 Hwy, Indian River, MI 49749 | 2006-07-20 |
| 1518983006 | Jennifer A Atkins | Pediatrics | 3860 S. Straits Highway, Indian River, MI 49749 | 2006-07-15 |
| 1659871705 | Sharon Vadovic | Pharmacist | 3944 S Straits Hwy, Indian River, MI 49749 | 2018-02-15 |
| 1639420557 | Munson Healthcare Otsego Memorial Hospital | General Practice | 3860 S Straits Hwy, Indian River, MI 49749 | 2012-10-02 |
| Find all providers in zip 49749 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609800119 | Robin L Batchelor | Physician Assistant | 6135 Cressy St, Indian River, MI 49749 | 2006-07-10 |
| 1689908550 | Kerri Anne Katona | Physician Assistant | 3696 S Straits Hwy, Indian River, MI 49749-5136 | 2009-09-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164022331 | Anna Lynn Shrift | Physician Assistant | 849 Black Hill Ln, Traverse City, MI 49696-8674 | 2020-10-27 |
| 1972102556 | Aaron Buckley | Physician Assistant | 567 Saint Louis St, Ferndale, MI 48220-2436 | 2020-10-23 |
| 1013516194 | Rebecca Mary Cronin | Physician Assistant | 4311 Kingsbrook Dr, Kalamazoo, MI 49006-3909 | 2020-10-20 |
| 1801495023 | Keriah Khairi Abd | Physician Assistant | 42836 Bloomingdale Dr, Sterling Heights, MI 48314-2843 | 2020-10-19 |
| 1154929016 | Angela Varghese | Physician Assistant | 461 Tanner Dr, Troy, MI 48085-4714 | 2020-10-13 |
| 1861090730 | Maloree Blayke Perkins | Physician Assistant | 20717 Coventry St, Clinton Twp, MI 48035-1603 | 2020-10-13 |
| 1801494000 | Sarah Puchala Lucero | Physician Assistant | 25614 Wilson Dr, Dearborn Heights, MI 48127-3427 | 2020-10-12 |
| 1871191007 | Julia Marie Tucker | Physician Assistant | 12250 E Ridge Dr, Bruce Twp, MI 48065-2011 | 2020-10-10 |
| 1164020301 | Sara Whitneyann Vandeman | Physician Assistant | 7901 S 12th St Ste 101, Portage, MI 49024-3831 | 2020-10-10 |
| 1831796267 | Jowharh Zindani | Physician Assistant | 12020 Mitchell St, Hamtramck, MI 48212-2722 | 2020-10-08 |
| Find all providers with the same taxonomy | ||||
| City | INDIAN RIVER |
| Zip Code | 49749 |
Please comment or provide details below to improve the information on MR. JOHN DAVID 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.