Wallace L Vinson, RSA

Primary specialty

SpecialistTaxonomy code 174400000X

License

238000232 Issued in IL

Practice address

260 S Schmidt Rd Ste G
Bolingbrook, IL 60440-3087

Phone

(630) 754-7760

Fax

(630) 754-7761

NPI assigned

Jul 29, 2009

Last updated

Oct 6, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Epic Surgical Solutions LLC

  dba Epic Surgical Solutions

  • Surgical Physician Assistant
  • Bolingbrook, IL
  • NPI 1598002735
  NPD
• Neurocyst Incorporated

  • Surgery Physician
  • Joliet, IL
  • NPI 1780155325
  NPD (past)

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

{
    "created_epoch": "1248825600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696550400000",
    "number": "1235360959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "260 S SCHMIDT RD STE G",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604403087",
            "telephone_number": "630-754-7760",
            "fax_number": "630-754-7761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "260 S SCHMIDT RD STE G",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604403087",
            "telephone_number": "630-754-7760",
            "fax_number": "630-754-7761"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VINSON",
        "first_name": "WALLACE",
        "middle_name": "L",
        "name_prefix": "Mr.",
        "credential": "RSA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-07-29",
        "last_updated": "2023-10-06",
        "certification_date": "2023-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "IL",
            "license": "238000232",
            "primary": true
        },
        {
            "code": "246ZS0410X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Surgical Technologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Heidi Jo Viehman
• Village Family Counseling, LLC
• Village of Bolingbrook Illinois
• Glaiza Marie Villarosa
• Vinod Motiani MD SC
• Visionworks, Inc (Visionworks)
• Vna Health Care
• Erika Vondra, PHARMD
• Poonam Wadhwani, D.D.S.
• Jessica Dawn Wainer, SSP

• Specialist in Bolingbrook, IL
• Providers in Bolingbrook, IL by specialty
• Specialist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2023; 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.