Wallace S. Wilder MD

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

3655 Issued in MT

Legal business name

WALLACE S. WILDER MD

Doing business as

Sunny View Pediatrics

Practice address

210 Sunnyview LN
Suite 103
Kalispell, MT 59901-3135

Phone

(406) 752-8300

Fax

(406) 752-3542

NPI assigned

Dec 8, 2006

Last updated

Aug 15, 2011By 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

Mrs. Trudy B. Waggener

Title

Office Manager

Phone

(406) 752-8300

Specialties & licenses 1

Addresses

Other identifiers 7

Other names 1

• Sunny View Pediatrics Doing business as

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

{
    "created_epoch": "1165536000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1313366400000",
    "number": "1659431013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 SUNNYVIEW LN",
            "address_2": "SUITE 103",
            "city": "KALISPELL",
            "state": "MT",
            "postal_code": "599013135",
            "telephone_number": "406-752-8300",
            "fax_number": "406-752-3542"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 SUNNYVIEW LN",
            "address_2": "SUITE 103",
            "city": "KALISPELL",
            "state": "MT",
            "postal_code": "599013135",
            "telephone_number": "406-752-8300",
            "fax_number": "406-752-3542"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALLACE S. WILDER MD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-08",
        "last_updated": "2011-08-15",
        "status": "A",
        "authorized_official_last_name": "WAGGENER",
        "authorized_official_first_name": "TRUDY",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "406-752-8300",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "MT",
            "license": "3655",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0066495",
            "state": "MT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0437529",
            "state": "MT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS - WALLACE WILDER MD",
            "identifier": "08110",
            "state": "MT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS - VALERIE BEEBE",
            "identifier": "371330",
            "state": "MT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS - MICHAEL SCHWALLER",
            "identifier": "92168",
            "state": "MT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0032344",
            "state": "MT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS - LYNN A. DYKSTRA MD",
            "identifier": "95755",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sunny View Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Walker Wellness LLC
• James Johnathon Walker
• John David Walker, M.D.
• Kelly Mason Walker, DNP, FNP
• Keelin Sweeney Wall, AGACNP-BC
• Rodney James Wallette, M.S., C.R.C.
• Walmart Inc. (Walmart Pharmacy 10-2259)
• Miri'Ikai Walter, LCPC, LAC, NPT-C,
• Misty Elaine Walters-Territo, D.C.
• Mark Steven Walters, RPH

• Primary Care Clinic/Center in Kalispell, MT
• Providers in Kalispell, MT by specialty
• Primary Care Clinic/Center in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2011; 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.