MR. HEATH WADE WALLACE (NPI# 1558323725) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558323725 |
| Entity Type | Individual |
| Full Name | MR. HEATH WADE WALLACE |
| Credential | IDC |
| Practice Address |
Uss Theodore Roosevelt Cvn 71 Medical Department Fpo AE 09599 2871 |
| Mailing Address |
1973 Big Boulder Dr Virginia Beach VA 23456-6126 |
| Practice Telephone | 7574456230 |
| Mailing Telephone | 7574711746 |
| Enumeration Date | 2006-04-04 |
| Last Update Date | 2008-04-20 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1710I1002X |
Military Health Care Provider Specialization: Independent Duty Corpsman |
Other Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811010069 | Heath R Wallace | Dentist | 13160 Main Street, Weston, OH 43569 | 2007-04-10 |
| Street Address |
USS THEODORE ROOSEVELT CVN 71 MEDICAL DEPARTMENT |
| City | FPO |
| State | AE |
| Zip Code | 09599 2871 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912431826 | Courtney Nicole Smith | Military Health Care Provider | Uss Theodore Roosevelt Cvn 71, Unit 10025 Medical, Fpo, AP 96632 | 2017-04-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053509190 | Amanda Lynn Mcdevitt | Military Health Care Provider | Uss Theodore Roosevelt, Cvn 71, Fpo, AE 09599 2871 | 2007-10-12 |
| 1578797643 | Venson Matthew Graves | Spec/Tech, Pathology | Uss Theodore Roosevelt # 71, Cvn-71, Fpo, AE 09599-2871 | 2009-05-05 |
| 1033201736 | Mary Jo-anne Guinto | Dental Hygienist | Uss Theodore Roosevelt Cvn-71, Dental Department Fpo Ae 09599, Norfolk, VA 09599-2871 | 2006-09-29 |
| 1205895059 | Deborah Ann Hinkley | Family Medicine | Senior Medical Officer, Uss Theodore Roosevelt, Cvn-71, Fpo Ae, NY 09599-2871 | 2006-03-21 |
| 1730176157 | Myra Valdez Martin | Dentist | Uss Theodore Roosevelt, Fpo, AP 09599-2871 | 2005-09-30 |
| 1659786515 | Michael Richard Owen | Dentist | Uss Theodore Roosevelt, Fpo, AE 09599-2871 | 2014-06-30 |
| 1720386931 | Sharla Darlene Bustamante | Military Health Care Provider | Uss Theodore Roosevelt, Cvn 71, Fpo, AE 09599-2871 | 2011-03-11 |
| 1174666218 | Scott Wagner Norton | Physical Therapist | Uss Theodore Roosevelt Cvn-71, Fpo Ae, VA 09599-2871 | 2007-02-15 |
| 1780671123 | Linda Painter Niemeyer | Dentist | Uss Theodore Roosevelt, Fpo, AP 09599-2871 | 2005-09-30 |
| Taxonomy Code | 1710I1002X |
| Grouping | Other Service Providers |
| Classification | Military Health Care Provider |
| Specialization | Independent Duty Corpsman |
| A Navy Independent Duty Corpsman (IDC) is an active duty Sailor who has successfully completed one of the Navy's specific IDC training programs. IDCs are formally trained and educated to perform primary medical care and minor surgical services in a variety of health care and non-health care settings worldwide under indirect physician supervision. IDCs provide care to Department of Defense operational forces and other supporting forces such as contractors and foreign nationals. |
| Notes: Source: Bureau of Medicine and Surgery, Department of the Navy [7/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538768833 | James Blake Weldon | Military Health Care Provider | Unit 100517 Bx 1, Fpo, AP 09655 | 2020-10-19 |
| 1740803279 | Issa Khalil | Military Health Care Provider | Uss Donald Cook, Fpo, AE 09566 | 2020-05-19 |
| 1396370623 | Daniel Rocha Moy | Military Health Care Provider | Uss Thunderbolt (pc-12), Fpo, AE 09588 | 2020-03-06 |
| 1639701634 | Stephen Henderson | Military Health Care Provider | 3d Recon Bn, Force Co., Unit 36180, Fpo, AP 96389-6180 | 2020-02-07 |
| 1649810219 | Maxwell Onyedikachi Osisioma | Military Health Care Provider | Psd-18, Macg-18, 1st Maw Unit 37172, Fpo, AP 96372 | 2020-01-13 |
| 1508406273 | Daniel Levin | Military Health Care Provider | 3d Recon Bn Aid Station, Fpo, AP 96389-6189 | 2020-01-10 |
| 1053955609 | Christopher Zartman | Military Health Care Provider | Camp Foster, Okinawa Japan, Fpo, AP 96379-0005 | 2019-11-06 |
| 1912553975 | Brandon Joseph Dapper | Military Health Care Provider | Camp Lejeune, Nc, 2d Reconnaissance Battalion Battalion Aid Station, Fpo, AA 28542-0138 | 2019-08-15 |
| 1518525583 | William Edward Mcbreen Jr. | Military Health Care Provider | Coastal Riverine Group 1 Detachment Guam, Fpo, AP 96540-1400 | 2019-06-04 |
| 1558832345 | Nathaniel Franklin Campbell | Military Health Care Provider | Rr 612 Everett Creek Rd, Camp Lejuene, Fpo, AE 28542 | 2018-12-06 |
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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.