Walls Medicine Clinic LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

11458R Issued in LA

Legal business name

WALLS MEDICINE CLINIC LLC

Practice address

1801 Fairfield Ave. Ste 200
Shreveport, LA 71101

Phone

(318) 675-1800

Fax

(318) 675-1818

NPI assigned

Nov 29, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Wendell E. Wall, M.D.NPI 1639174105

Title

Owner

Phone

(318) 675-1800

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in LA

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

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/18281/brand/1/csg/1/fhir/r4

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Wendell E. Wall, M.D.

  • Internal Medicine Physician
  • Shreveport, LA
  • NPI 1639174105
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1196294400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1541721600000",
    "number": "1497937601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1801 FAIRFIELD AVE. STE 200",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "71101",
            "telephone_number": "318-675-1800",
            "fax_number": "318-675-1818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 FAIRFIELD AVE. STE 200",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "71101",
            "telephone_number": "318-675-1800",
            "fax_number": "318-675-1818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALLS MEDICINE CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-29",
        "last_updated": "2018-11-09",
        "status": "A",
        "authorized_official_last_name": "WALL",
        "authorized_official_first_name": "WENDELL",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "318-675-1800",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "LA",
            "license": "11458R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1663841",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lauren F. Wallace, DDS
• Shericka Wallace
• Thaddaeus Wallace, PHARMD
• Jordan Wallek, BCABA
• Tremeka Waller
• Deonica Walls
• Elizabeth Walls, P.T.
• Heather Walls
• Kelly Ann Walls, LPN
• Catherine Walsh, MSW

• Internal Medicine Physician in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Internal Medicine Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2018; 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.