Perry Wallace (NPI# 1922044502, PAC ID# 4981516432) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is EMERGENCY MEDICINE.
| Nation Provider ID (NPI) | 1922044502 |
| PAC ID by PECOS | 4981516432 |
| Professional Enrollment ID | I20040526000946 |
| Full Name | Perry Wallace |
| Organization Legal Name | LAIRD HOSPITAL, INC. |
| Address |
25117 Hwy 15 Union MS 39365-9088 |
| Phone Number | 6017748214 |
| Gender | M |
| Credential | MD |
| Medical School | UNIVERSITY OF MISSISSIPPI SCHOOL OF MEDICINE |
| Graduation Year | 1983 |
| Primary Specialty | EMERGENCY MEDICINE |
| Secondary Specialties | INTERNAL MEDICINE |
| Group Practice PAC ID | 7214991769 |
| Number of Group Practice Members | 42 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 251322 | LAIRD HOSPITAL INC |
| 011304 | CHOCTAW GENERAL HOSPITAL |
| 010092 | D C H REGIONAL MEDICAL CENTER |
| 250093 | BOLIVAR MEDICAL CENTER |
| Address | Phone | Organization |
|---|---|---|
| 401 Vanity Fair Ave, Butler, AL 36904-3032 | 2054599100 | RUSH HOSPITAL/BUTLER,INC |
| 2700 Hospital Dr, Northport, AL 35476-3360 | 2053334500 | RELIAS EMERGENCY MEDICINE SPECIALISTS OF NORTHPORT, LLC |
| 809 University Blvd E, Tuscaloosa, AL 35401-2029 | 2057597111 | RELIAS EMERGENCY MEDICINE SPECIALISTS OF REGIONAL, LLC |
| 25117 Hwy 15, Union, MS 39365-9088 | 6017748214 | LAIRD HOSPITAL, INC. |
| Organization Legal Name | LAIRD HOSPITAL, INC. |
| Physicians | 31 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Hunter J Harrison | Family Medicine | Laird Hospital, Inc. | 1500 Hwy 19 N, Meridian, MS 39307-5335 |
| Alisha Miller | Nurse Practitioner | Laird Hospital, Inc. | 1106 Central Dr, Philadelphia, MS 39350-8972 |
| Michelle L Roark | Certified Nurse Midwife (cnm) | Laird Hospital, Inc. | 1221 24th Ave, Meridian, MS 39301-3926 |
| Cynthia B. Massey | Nurse Practitioner | Laird Hospital, Inc. | 14884 Hwy 15, Decatur, MS 39327-9697 |
| Frederick T Duggan | Pulmonary Disease | Laird Hospital, Inc. | 25117 Hwy 15, Union, MS 39365-9088 |
| Angela K Skinner | Nurse Practitioner | Laird Hospital, Inc. | 9097 Collinsville Rd, Collinsville, MS 39325-9779 |
| Mary E Spreafico | Nurse Practitioner | Laird Hospital, Inc. | 24345 Hwy 15, Union, MS 39365-8575 |
| Patrick H Eakes | Internal Medicine | Laird Hospital, Inc. | 1106 Central Dr, Philadelphia, MS 39350-8972 |
| Edward Daniel Henderson Jr. | Family Medicine | Laird Hospital, Inc. | 9097 Collinsville Rd, Collinsville, MS 39325-9779 |
| Walter L Willis | Emergency Medicine | Laird Hospital, Inc. | 25117 Hwy 15, Union, MS 39365-9088 |
| Street Address |
25117 HWY 15 |
| City | UNION |
| State | MS |
| Zip | 39365-9088 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Frederick T Duggan | Pulmonary Disease | Laird Hospital, Inc. | 25117 Hwy 15, Union, MS 39365-9088 |
| Walter L Willis | Emergency Medicine | Laird Hospital, Inc. | 25117 Hwy 15, Union, MS 39365-9088 |
| Johnathan Y Lee | General Surgery | Laird Hospital, Inc. | 25117 Hwy 15, Union, MS 39365-9088 |
| Deborah A Hester | Emergency Medicine | Laird Hospital, Inc. | 25117 Hwy 15, Union, MS 39365-9088 |
| Courtney T Adkins | Nurse Practitioner | Laird Hospital, Inc. | 25117 Hwy 15, Union, MS 39365-9088 |
| Bonnie A. Woods | Certified Registered Nurse Anesthetist | Laird Hospital, Inc. | 25117 Hwy 15, Union, MS 39365-9088 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Mary E Spreafico | Nurse Practitioner | Laird Hospital, Inc. | 24345 Hwy 15, Union, MS 39365-8575 |
| Christopher H Moore | Family Medicine | Laird Hospital, Inc. | 24345 Hwy 15, Union, MS 39365-8575 |
| Jessica S. Mcdaniel | Nurse Practitioner | Laird Hospital, Inc. | 24345 Hwy 15, Union, MS 39365-8575 |
| Russell E Belenchia | Emergency Medicine | Laird Hospital, Inc. | 24345 Hwy 15, Union, MS 39365-8575 |
| John E Mann | Family Practice | Laird Hospital, Inc. | 24345 Hwy 15, Union, MS 39365-8575 |
| Robert K Kiehn | Emergency Medicine | Laird Hospital, Inc. | 24345 Hwy 15, Union, MS 39365-8575 |
| City | UNION |
| Zip Code | 39365 |
| Specialty | EMERGENCY MEDICINE |
| City + Specialty | UNION + EMERGENCY MEDICINE |
Please comment or provide details below to improve the information on Perry Wallace.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.