Wallace B. Moncrief, PA-C
Individual provider Active NPI Family Medicine Physician · Morganton, NC
NPI 1770516965 · NPPES record last updated Aug 14, 2007
Key facts
- NPI
- 1770516965
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 100450 (NC)
- Practice address
- 103 Medical Heights Dr
Morganton, NC 28655-5197 - Phone
- (828) 391-2014
- Fax
- (828) 437-1034
- NPI assigned
- Jul 9, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100730000951 | NC | Practitioner - Physician Assistant | 5597898346 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| High Country Community Health | Current |
Accepting new patients | |
| High Country Community Health | Family Medicine | Current |
Accepting new patients |
Locations
560 Malcolm Blvd
Connelly Springs, NC 28612
Phone (828) 437-7702
301 E Meeting St
Ste 101
Morganton, NC 28655
Phone (828) 608-0800
448 Cranberry St
Newland, NC 28657
Phone (828) 737-0221
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/JJJEBD
- wallace.moncrief.1@18322.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 100450 | NC | Yes |
Addresses
Primary practice location
103 Medical Heights Dr
Morganton, NC 28655-5197
Mailing address
103 Medical Heights Dr
Morganton, NC 28655-5197
Phone (828) 391-2014
Other providers in Morganton, NC
- Lillian Modak
- Jason Moffitt
- Suneel Mohammed
- Masood Mohiuddin
- Matthew Sheldon Moncrief
- Mario Montalvo
- Carolyn Mook
- James McDowell Moore
- Nicole Marie Moore
- Mario Moraga
All providers in Morganton, NC · Family Medicine Physician in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 14, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.