NPIMap

Organization Active NPI

Wallace Orthopaedics and Sports Medicine

  • Orthopaedic Surgery Physician
  • Rockwall, TX
National Provider Identifier
1740306208
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
J3932 Issued in TX
Legal business name
WALLACE ORTHOPAEDICS AND SPORTS MEDICINE
Practice address
6701 Heritage Pkwy
Suite 140
Rockwall, TX 75087-8747
Phone
(972) 463-1253
Fax
(972) 463-0758
NPI assigned
Mar 22, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Jeffrey S Wallace, M.D.NPI 1629089156
Title
President
Phone
(972) 463-1253

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207X00000X J3932 TX Primary

Addresses

Primary practice location

6701 Heritage Pkwy
Suite 140
Rockwall, TX 75087-8747

Mailing address

6701 Heritage Pkwy
Suite 140
Rockwall, TX 75087-8747
Phone (972) 463-1253

National Provider Directory

National Provider Directory

Locations

6701 Heritage Pkwy
Ste 140
Rockwall, TX 75087
Phone (972) 463-1253

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1174521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1740306208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6701 HERITAGE PKWY",
            "address_2": "SUITE 140",
            "city": "ROCKWALL",
            "state": "TX",
            "postal_code": "750878747",
            "telephone_number": "972-463-1253",
            "fax_number": "972-463-0758"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6701 HERITAGE PKWY",
            "address_2": "SUITE 140",
            "city": "ROCKWALL",
            "state": "TX",
            "postal_code": "750878747",
            "telephone_number": "972-463-1253",
            "fax_number": "972-463-0758"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALLACE ORTHOPAEDICS AND SPORTS MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "972-463-1253",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery",
            "state": "TX",
            "license": "J3932",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockwall, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.