Urgent Care of Wallace, PLLC

Primary specialty

Urgent Care Clinic/CenterTaxonomy code 261QU0200X

Legal business name

URGENT CARE OF WALLACE, PLLC

Practice address

112 Medical Village Dr Ste G
Wallace, NC 28466-1665

Phone

(910) 285-4100

NPI assigned

Oct 7, 2020

Last updated

Oct 7, 2020By 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

Erica Smith

Title

Billing Specialist

Phone

(910) 285-4100

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Practitioners 6

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.

• Jeffrey Wayne Autry, FNP

  • Nurse Practitioner
  • Clinton, NC
  • NPI 1063474559
  Medicare reassignment NPD
• Jennifer Nicole Brennan, FNP

  • Nurse Practitioner
  • Wallace, NC
  • NPI 1730804907
  Medicare reassignment NPD
• Mary Anna Johnson, FNP-BC

  • Nurse Practitioner
  • Wallace, NC
  • NPI 1720541220

  Single Specialty

  Medicare reassignment NPD
• Daniel Michael Ricci, M.D.

  • Internal Medicine Physician
  • Wallace, NC
  • NPI 1528067519
  Medicare reassignment NPD
• Katherine Price Sutherland, FNP-C

  • Family Nurse Practitioner
  • Jacksonville, NC
  • NPI 1720636038
  Medicare reassignment NPD
• David Floyd Hoag II, PA-C

  • Physician Assistant
  • Hampstead, NC
  • NPI 1962478081
  Medicare reassignment

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

{
    "created_epoch": "1602028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602028800000",
    "number": "1699372243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4350 NC HWY 11",
            "city": "WILLARD",
            "state": "NC",
            "postal_code": "284787006",
            "telephone_number": "910-290-0561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 MEDICAL VILLAGE DR STE G",
            "city": "WALLACE",
            "state": "NC",
            "postal_code": "284661665",
            "telephone_number": "910-285-4100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "URGENT CARE OF WALLACE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-07",
        "last_updated": "2020-10-07",
        "certification_date": "2020-09-29",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "ERICA",
        "authorized_official_title_or_position": "BILLING SPECIALIST",
        "authorized_official_telephone_number": "910-285-4100"
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bethany Cavan Treibley, FNP-C
• Tri-County Youth Services, Inc.
• Tri-County Youth Services, Inc.
• Trinity Family Medicine, P.a.
• Olivia Austen Trull, OTR/L
• Wal-Mart Stores East LP (Wal-Mart Pharmacy 10-1352)
• Walgreen Co. (Walgreens #10088)
• Kayla Sholar Walker, FNP
• Wallace Drug Co Inc
• Wallace Gardens Inc

• Urgent Care Clinic/Center in Wallace, NC
• Providers in Wallace, NC by specialty
• Urgent Care Clinic/Center in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2020; 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.