Active NPI
Alexander Wallace
- Registered Nurse
- Martinsburg, WV
National Provider Identifier
1083364772
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 107631
- Practice address
- 208 Old Mill Rd
Martinsburg, WV 25401-9219 - Phone
- (304) 263-5680
- NPI assigned
- Mar 25, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 107631 | WV | Primary |
Addresses
Primary practice location
208 Old Mill Rd
Martinsburg, WV 25401-9219
Mailing address
208 Old Mill Rd
Martinsburg, WV 25401-9219
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 107631 | WV | MD | Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Panhandle Home Health Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Home Health Agency
- Martinsburg, WV
- NPI 1174588750
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1648166400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1648166400000",
"number": "1083364772",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "208 OLD MILL RD",
"city": "MARTINSBURG",
"state": "WV",
"postal_code": "254019219"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "208 OLD MILL RD",
"city": "MARTINSBURG",
"state": "WV",
"postal_code": "254019219",
"telephone_number": "304-263-5680"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "ALEXANDER",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-03-25",
"last_updated": "2022-03-25",
"certification_date": "2022-03-25",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "WV",
"license": "107631",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Martinsburg, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.