Active NPI
Byron Richard Wadley, MD
- Psychiatry Physician
- Longview, TX
National Provider Identifier
1174537906
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- G0245
- Practice address
- 3400 W Marshall Ave Ste 430
Longview, TX 75604-5073 - Phone
- (903) 297-9400
- Fax
- (903) 297-3810
- NPI assigned
- Jul 28, 2006
- Last updated
- Sep 23, 2019
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | G0245 | TX | Primary |
Addresses
Primary practice location
3400 W Marshall Ave Ste 430
Longview, TX 75604-5073
Mailing address
3400 W Marshall Ave Ste 430
Longview, TX 75604-5073
Phone (903) 297-9400
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 132886607 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jul 1, 2015 through Jul 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G0245 | TX | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154044800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1569196800000",
"number": "1174537906",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3400 W MARSHALL AVE STE 430",
"city": "LONGVIEW",
"state": "TX",
"postal_code": "756045073",
"telephone_number": "903-297-9400",
"fax_number": "903-297-3810"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3400 W MARSHALL AVE STE 430",
"city": "LONGVIEW",
"state": "TX",
"postal_code": "756045073",
"telephone_number": "903-297-9400",
"fax_number": "903-297-3810"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WADLEY",
"first_name": "BYRON",
"middle_name": "RICHARD",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-28",
"last_updated": "2019-09-23",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "TX",
"license": "G0245",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "132886607",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Longview, TX
- Mark Ziggy Vrana
- Donna Vu
- Wa-Mart Stores Texas, LP (Vision Center 30-0399)
- Gregory Kyle Wacasey, O. D.
- Kimberly Kaye Waddell
- Madison Moore Wagner, FNP-C
- Wal-Mart Stores Texas LLC (Walmart Pharmacy 10-3828)
- Wal-Mart Stores Texas LLC (Walmart Pharmacy 10-0398)
- Wal-Mart Stores Texas LLC (Walmart Pharmacy 10-4114)
- Wal-Mart Stores Texas LLC (Walmart Pharmacy 10-0399)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.