Allen Wallace, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

192839-4406 Issued in UT

Practice address

250 W 300 N
Roosevelt, UT 84066-2336

Phone

(435) 722-6163

Fax

(435) 722-9291

NPI assigned

Apr 10, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in UT

Enrollment records 1

Medicare enrollment (NPD)

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 and National Provider Directory roles.

• Uintah Basin Medical Center

  • General Acute Care Hospital
  • Roosevelt, UT
  • NPI 1871556217
  Medicare reassignment NPD
• Ubmc Anesthesiology

  • Certified Registered Nurse Anesthetist
  • Roosevelt, UT
  • NPI 1043643877
  Medicare reassignment
• Uintah Basin Medical Center

  • Community/Retail Pharmacy
  • Vernal, UT
  • NPI 1285420414
  NPD

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

{
    "created_epoch": "1144627200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1196380800000",
    "number": "1295798163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 W 300 N",
            "city": "ROOSEVELT",
            "state": "UT",
            "postal_code": "840662336",
            "telephone_number": "435-722-6163",
            "fax_number": "435-722-9291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 W 300 N",
            "city": "ROOSEVELT",
            "state": "UT",
            "postal_code": "840662336",
            "telephone_number": "435-722-6163",
            "fax_number": "435-722-9291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "ALLEN",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-10",
        "last_updated": "2007-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "UT",
            "license": "192839-4406",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "D0808",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Uintah Basin Medical Center Inc
• Uintah Basin Spine and Disc Center, PC
• Uintah Basin Tricounty Mental Health & Substance Abuse Local Authority
• Valiant Endeavors Counseling Services LLC
• Shailynn Marie Walker
• Carrie Anne Wallace
• Weston Ross Weaver, RPH
• Jason Allen Weech
• John Spencer Wells, MD
• Kristopher Jon Wentworth

• Certified Registered Nurse Anesthetist in Roosevelt, UT
• Providers in Roosevelt, UT by specialty
• Certified Registered Nurse Anesthetist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.