MICHAEL C WALLACE (NPI# 1932192556) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1932192556 |
| Entity Type | Individual |
| Full Name | MICHAEL C WALLACE |
| Credential | MD |
| Practice Address |
7685 Winchester Rd Memphis TN 38125-2202 |
| Mailing Address |
Po Box 405827 Atlanta GA 30384-5800 |
| Practice Telephone | 9017526963 |
| Practice Fax Number | 9017515540 |
| Enumeration Date | 2005-08-30 |
| Last Update Date | 2016-10-25 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | MD36875 | TN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TN | BCBS, TN | 4065344 | 01 |
| TN | AETNA | 7128500 | 01 |
| TN | CIGNA | 1474033 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417014424 | Michael J Wallace | Dentist | 1600 E 19th St, Suite 301, Edmond, OK 73013-6622 | 2007-01-02 |
| 1518042696 | Michael J. Wallace | Dentist | 1263 High St, Auburn, CA 95603-5016 | 2006-10-26 |
| 1124127279 | Michael James Wallace | Dentist | 1195 W Mason St, Green Bay, WI 54303-2045 | 2006-09-22 |
| 1679585038 | Michael Patrick Wallace | Dentist | 9225 Manchester Rd, Suite 101, Saint Louis, MO 63144-2640 | 2006-08-13 |
| 1467438937 | Michael Lloyd Wallace | Pathology | 522 Alpha Dr, Pittsburgh, PA 15238-2912 | 2005-12-16 |
| 1609356864 | Michael Wallace | Physical Therapy Assistant | 5455 Knickerbocker Rd, San Angelo, TX 76904-7711 | 2018-08-17 |
| 1225579899 | Michael Wallace | Counselor | 500 Allerton St, Second Floor, Redwood City, CA 94063-1519 | 2017-03-16 |
| 1376922948 | Michael Taylor Wallace | Ophthalmology | 930 Madison Ave Ste 200, Memphis, TN 38103 | 2015-05-28 |
| 1194029777 | Michael T Wallace | Nurse Practitioner | 9900 Bren Rd E, Minnetonka, MN 55343-9664 | 2010-12-22 |
| 1003116658 | Michael Eugene Wallace | Psychologist | 201 E Liberty St, Suite 2, Ann Arbor, MI 48104-2118 | 2010-10-29 |
| Street Address |
7685 WINCHESTER RD |
| City | MEMPHIS |
| State | TN |
| Zip Code | 38125-2202 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346233913 | Melanie L Woodall | Family Medicine | 7685 Winchester Rd, Memphis, TN 38125-2202 | 2005-08-29 |
| 1609035088 | Susan D Ruch | Physical Therapist | 7685 Winchester Rd, Memphis, TN 38125-2202 | 2008-06-02 |
| 1245223866 | Charles J Woodall | Family Medicine | 7685 Winchester Rd, Memphis, TN 38125-2202 | 2005-08-30 |
| 1316930944 | Jay D Smith | Family Medicine | 7685 Winchester Rd, Memphis, TN 38125-2202 | 2005-08-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144798448 | Ronald Penn Jr. | Day Training, Developmentally Disabled Services | 4751 Harvest Park Dr., Memphis, TN 38125 | 2018-11-05 |
| 1417458944 | Crestwyn Health Group, LLC | Psychiatry & Neurology | 9485 Crestwyn Hills Cv, Memphis, TN 38125 | 2018-02-21 |
| 1982121323 | Ruthie Rayford | Non-emergency Medical Transport (VAN) | 7244 Grande Bay Cove, Memphis, TN 38125 | 2017-08-25 |
| 1952769119 | Crestwyn Health Group, LLC | Psychiatric Hospital | 9485 Crestwyn Hills Cove, Memphis, TN 38125 | 2016-02-03 |
| 1033590500 | Katherine Brown | Optometrist | 7706 Winchester Road, Suite 105, Memphis, TN 38125 | 2015-06-10 |
| 1073856514 | Quaneshia R Farris | Nurse Practitioner | 7685 Winchester Rd Ste 100, Memphis, TN 38125 | 2013-04-03 |
| 1225379811 | Americare At Southbreeze Assisted Living, LLC | Assisted Living Facility | 3168 Hacks Road Cross, Memphis, TN 38125 | 2013-03-07 |
| 1780934281 | Freds Stores of Tennessee Inc | Pharmacy | 7143 Winchester Rd, Memphis, TN 38125 | 2012-09-12 |
| 1174893598 | Andi Marie Anderson | Nurse Anesthetist, Certified Registered | 3340 Players Club Parkway, Suite 350, Memphis, TN 38125 | 2012-01-02 |
| 1285938266 | Melita Robbins | Behavioral Analyst | 8922 E. Trophy Way, Ste 202, Memphis, TN 38125 | 2011-01-05 |
| Find all providers in zip 38125 | ||||
| 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 |
|---|---|---|---|---|
| 1568069201 | Warren Hilliard | Family Medicine | 7625 Hwy64, 107, Memphis, TN 38133 | 2020-10-06 |
| 1144835539 | Memphis Family Care | Family Medicine | 5818 Winchester Rd, Memphis, TN 38115-4711 | 2020-09-11 |
| 1538772868 | Longmire Health Group | Family Medicine | 1331 Union Ave Ste 1024, Memphis, TN 38104-7509 | 2020-08-26 |
| 1912526088 | Sanitas Medical Center of Tennessee PC | Family Medicine | 1200 E Raines Rd, Suite 101, Memphis, TN 38116 | 2020-04-09 |
| 1508496829 | Courtney Cordo | Family Medicine | 5901 Shelby Oaks Dr Ste 100, Memphis, TN 38134-7328 | 2020-01-26 |
| 1801431499 | Geriatric and Hospice Associates of The Mid South Pllc | Family Medicine | 6025 Walnut Grove Rd Ste 317, Memphis, TN 38120-2131 | 2019-11-07 |
| 1831627280 | Humanity LLC | Family Medicine | 451 S Perkins Rd Apt 2, Memphis, TN 38117-3952 | 2017-05-30 |
| 1366979098 | Cross Medical Primary Care | Family Medicine | 6222 E. Shelby Drive, Memphis, TN 38141 | 2017-05-12 |
| 1619403870 | Cross Medical Primary Care | Family Medicine | 6222 East Shelby Drive, Memphis, TN 38141 | 2017-05-10 |
| 1417304569 | John Clark Shell | Family Medicine | 150 Harbor Creek Dr, Memphis, TN 38103 | 2016-05-18 |
| 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.