Wallace Mann MD PA

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

K6771 Issued in TX

Legal business name

WALLACE MANN MD PA

Practice address

202 S McGee St
Borger, TX 79007-4022

Phone

(806) 273-7118

Fax

(806) 274-6070

NPI assigned

Jun 6, 2007

Last updated

May 13, 2024By 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

Mr. Wallace Mann, MDNPI 1326036856

Title

Owner Ceo

Phone

(806) 273-7118

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Interoperability endpoints

• FHIR API: https://fhir.fhirpoint.open.allscripts.com/fhirroute/open/76444

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Wallace Mann, MD

  • Family Medicine Physician
  • Borger, TX
  • NPI 1326036856
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1181088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715558400000",
    "number": "1437352770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "202 S MCGEE ST",
            "city": "BORGER",
            "state": "TX",
            "postal_code": "790074022",
            "telephone_number": "806-273-7118",
            "fax_number": "806-274-6070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 S MCGEE ST",
            "city": "BORGER",
            "state": "TX",
            "postal_code": "790074022",
            "telephone_number": "806-273-7118",
            "fax_number": "806-274-6070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALLACE MANN MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-06",
        "last_updated": "2024-05-13",
        "certification_date": "2024-05-13",
        "status": "A",
        "authorized_official_last_name": "MANN",
        "authorized_official_first_name": "WALLACE",
        "authorized_official_title_or_position": "OWNER CEO",
        "authorized_official_telephone_number": "806-273-7118",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "K6771",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "111983603",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "111983601",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• United Supermarkets LLC (United Pharmacy)
• Melodie Vann, FNP-C
• W.H.Landers, Jr., M.D., PLLC
• Wal-Mart Stores Texas LLC (Walmart Pharmacy 10-1516)
• Destiny Walesiak, COTA
• Kami Ware, M.S., CCC-SLP
• Ammon David Weber, MD
• White Deer Isd
• Huzaifa Yasin, DMD
• Kaisha D. Yeager, LPC-ASSOCIATE

• Family Medicine Physician in Borger, TX
• Providers in Borger, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.