Robert E Wallace (NPI# 1003950288, PAC ID# 6204001910) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA).
| Nation Provider ID (NPI) | 1003950288 |
| PAC ID by PECOS | 6204001910 |
| Professional Enrollment ID | I20160519000933 |
| Full Name | Robert E Wallace |
| Organization Legal Name | TUBA CITY REGIONAL HEALTH CARE CORPORATION |
| Address |
167 Main St Tcrhcc Mobile Medical Clinic Tuba City AZ 86045-0600 |
| Phone Number | 9282832501 |
| Gender | M |
| Graduation Year | 1983 |
| Primary Specialty | CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA) |
| Group Practice PAC ID | 4284542531 |
| Number of Group Practice Members | 119 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 030083 | ABRAZO SCOTTSDALE CAMPUS |
| Address | Phone | Organization |
|---|---|---|
| 3929 E Bell Rd, Phoenix, AZ 85032-2112 | 6029235000 | SUMMIT ANESTHESIA SERVICES PLLC |
| 167 Main St, Tcrhcc Mobile Medical Clinic, Tuba City, AZ 86045-0600 | 9282832501 | TUBA CITY REGIONAL HEALTH CARE CORPORATION |
| 167 N Main St, Tuba City Indian Medical Center, Tuba City, AZ 86045-0600 | 9282832094 | TUBA CITY REGIONAL HEALTH CARE CORPORATION |
| Organization Legal Name | TUBA CITY REGIONAL HEALTH CARE CORPORATION |
| Physicians | 133 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Eben J Clattenburg | Emergency Medicine | Tuba City Regional Health Care Corporation | 3 Miles S of Page Az Coppermine Rd, Lechee Health Facility, Page, AZ 86040 |
| Lena L Wong | Internal Medicine | Tuba City Regional Health Care Corporation | 167 N Main St, Tuba City Indian Medical Center, Tuba City, AZ 86045-0600 |
| Robert J Riether | Diagnostic Radiology | Tuba City Regional Health Care Corporation | 167 Main St, Tcrhcc Mobile Medical Clinic, Tuba City, AZ 86045-0600 |
| Richard L Holve | Family Medicine | Tuba City Regional Health Care Corporation | 167 Main St, Tcrhcc Mobile Medical Clinic, Tuba City, AZ 86045-0600 |
| Julia Shemek | Nurse Practitioner | Tuba City Regional Health Care Corporation | 167 Main St, Tcrhcc Mobile Medical Clinic, Tuba City, AZ 86045-0600 |
| Kirk Shim | Nurse Practitioner | Tuba City Regional Health Care Corporation | 167 Main St, Tcrhcc Mobile Medical Clinic, Tuba City, AZ 86045-0600 |
| Margaret E Blaisdell | Emergency Medicine | Tuba City Regional Health Care Corporation | 167 Main St, Tcrhcc Mobile Medical Clinic, Tuba City, AZ 86045-0600 |
| Corris E Archer | Obstetrics/gynecology | Tuba City Regional Health Care Corporation | 167 N Main St, Tuba City Indian Medical Center, Tuba City, AZ 86045-0600 |
| Eileen H Kim | Internal Medicine | Tuba City Regional Health Care Corporation | 167 Main St, Tcrhcc Mobile Medical Clinic, Tuba City, AZ 86045-0600 |
| Wendy A Shultis | Certified Nurse Midwife (cnm) | Tuba City Regional Health Care Corporation | 167 Main St, Tcrhcc Mobile Medical Clinic, Tuba City, AZ 86045-0600 |
| Street Address |
167 MAIN ST TCRHCC MOBILE MEDICAL CLINIC |
| City | TUBA CITY |
| State | AZ |
| Zip | 86045-0600 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Robert J Riether | Diagnostic Radiology | Tuba City Regional Health Care Corporation | 167 Main St, Tcrhcc Mobile Medical Clinic, Tuba City, AZ 86045-0600 |
| Richard L Holve | Family Medicine | Tuba City Regional Health Care Corporation | 167 Main St, Tcrhcc Mobile Medical Clinic, Tuba City, AZ 86045-0600 |
| Julia Shemek | Nurse Practitioner | Tuba City Regional Health Care Corporation | 167 Main St, Tcrhcc Mobile Medical Clinic, Tuba City, AZ 86045-0600 |
| Kirk Shim | Nurse Practitioner | Tuba City Regional Health Care Corporation | 167 Main St, Tcrhcc Mobile Medical Clinic, Tuba City, AZ 86045-0600 |
| Margaret E Blaisdell | Emergency Medicine | Tuba City Regional Health Care Corporation | 167 Main St, Tcrhcc Mobile Medical Clinic, Tuba City, AZ 86045-0600 |
| Eileen H Kim | Internal Medicine | Tuba City Regional Health Care Corporation | 167 Main St, Tcrhcc Mobile Medical Clinic, Tuba City, AZ 86045-0600 |
| Wendy A Shultis | Certified Nurse Midwife (cnm) | Tuba City Regional Health Care Corporation | 167 Main St, Tcrhcc Mobile Medical Clinic, Tuba City, AZ 86045-0600 |
| Alyssa M Pisani | Physical Therapy | Manual and Sports Physical Therapy, PC | 167 Main St, Southampton, NY 11968-4823 |
| Amanda R Jones | Physician Assistant | Tuba City Regional Health Care Corporation | 167 Main St, Tcrhcc Mobile Medical Clinic, Tuba City, AZ 86045-0600 |
| Jennifer Whitehair | Obstetrics/gynecology | Tuba City Regional Health Care Corporation | 167 Main St, Tcrhcc Mobile Medical Clinic, Tuba City, AZ 86045-0600 |
| Find all physicians in the same address | |||
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Lena L Wong | Internal Medicine | Tuba City Regional Health Care Corporation | 167 N Main St, Tuba City Indian Medical Center, Tuba City, AZ 86045-0600 |
| Corris E Archer | Obstetrics/gynecology | Tuba City Regional Health Care Corporation | 167 N Main St, Tuba City Indian Medical Center, Tuba City, AZ 86045-0600 |
| Henry Jl Van Dyk | Internal Medicine | Tuba City Regional Health Care Corporation | 167 N Main St, Tuba City Indian Medical Center, Tuba City, AZ 86045-0600 |
| Katherine B Glaser | Obstetrics/gynecology | Tuba City Regional Health Care Corporation | 167 N Main St, Tuba City Indian Medical Center, Tuba City, AZ 86045-0600 |
| Loran Jacobs | Certified Registered Nurse Anesthetist (crna) | Tuba City Regional Health Care Corporation | 167 N Main St, Tuba City Indian Medical Center, Tuba City, AZ 86045-0600 |
| Odette Oliveras | Internal Medicine | Tuba City Regional Health Care Corporation | 167 N Main St, Tuba City Indian Medical Center, Tuba City, AZ 86045-0600 |
| Kathleen A Harner | Obstetrics/gynecology | Tuba City Regional Health Care Corporation | 167 Main St, Tcrhcc Mobile Medical Clinic, Tuba City, AZ 86045-0600 |
| Audrey L Andzelik | Physician Assistant | Tuba City Regional Health Care Corporation | 167 Main St, Tcrhcc Mobile Medical Clinic, Tuba City, AZ 86045-0600 |
| Frank E Dalichow | Internal Medicine | Tuba City Regional Health Care Corporation | 167 Main St, Tcrhcc Mobile Medical Clinic, Tuba City, AZ 86045-0600 |
| Timothy J Decapite | Dermatology | Tuba City Regional Health Care Corporation | 167 Main St, Tcrhcc Mobile Medical Clinic, Tuba City, AZ 86045-0600 |
| Find all physicians in zip 86045 | |||
| City | TUBA CITY |
| Zip Code | 86045 |
| Specialty | CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA) |
| City + Specialty | TUBA CITY + CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA) |
Please comment or provide details below to improve the information on Robert E 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.