Wallace Home Medical Supplies

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

103383 Issued in CA

Legal business name

WALLACE HOME MEDICAL SUPPLIES

Practice address

1414 Park St
Paso Robles, CA 93446-2160

Phone

(805) 238-3935

Fax

(805) 238-3974

NPI assigned

Dec 6, 2006

Last updated

Apr 20, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Matthew Trago Wallace

Title

Owner

Phone

(805) 238-3935

Specialties & licenses 2

Addresses

Other identifiers 2

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1215096466",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1414 PARK ST",
            "city": "PASO ROBLES",
            "state": "CA",
            "postal_code": "934462160",
            "telephone_number": "805-238-3935",
            "fax_number": "805-238-3974"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1414 PARK ST",
            "city": "PASO ROBLES",
            "state": "CA",
            "postal_code": "934462160",
            "telephone_number": "805-238-3935",
            "fax_number": "805-238-3974"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALLACE HOME MEDICAL SUPPLIES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-06",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "TRAGO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "805-238-3935"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "CA",
            "license": "103383",
            "primary": true
        },
        {
            "code": "332BX2000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
            "state": "CA",
            "license": "18268",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DME03195F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD DME PROVIDER",
            "identifier": "ZZZ 08974 Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cynthia J Wakefield
• Wal Mart Stores, Inc. Dba Wal-Mart (Vision Center 30-2099)
• Angie C Walker, MA, PPS
• Darren Walker
• Dustin Walker
• Wallace Home Medical Supplies
• Sharon Simara Wallace, HS
• Walmart Inc. (Walmart Pharmacy 10-2099)
• Mary Margaret Ward, RPH
• Danielle Leigh Warren

• Durable Medical Equipment & Medical Supplies in Paso Robles, CA
• Providers in Paso Robles, CA by specialty
• Durable Medical Equipment & Medical Supplies in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.