Wallace Home Medical Supplies

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

WALLACE HOME MEDICAL SUPPLIES

Practice address

549 10TH St
Paso Robles, CA 93446-2510

Phone

(805) 238-3935

NPI assigned

Jun 30, 2008

Organization subpart

No

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

Authorized official

Name

Mr. Trago Wallace, ATS

Title

President

Phone

(805) 238-3935

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Wallace Home Medical Supplies

  • Durable Medical Equipment & Medical Supplies
  • San Luis Obispo, CA
  • NPI 1902200918

  0749486744

  Same PAC ID

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

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

{
    "created_epoch": "1214784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1371427200000",
    "number": "1790947828",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "549 10TH ST",
            "city": "PASO ROBLES",
            "state": "CA",
            "postal_code": "934462510",
            "telephone_number": "805-238-3935"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "549 10TH ST",
            "city": "PASO ROBLES",
            "state": "CA",
            "postal_code": "934462510",
            "telephone_number": "805-238-3935"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALLACE HOME MEDICAL SUPPLIES",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-30",
        "last_updated": "2013-06-17",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "TRAGO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "805-238-3935",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "ATS"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DME03195F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ 08974 Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Wal Mart Stores, Inc. Dba Wal-Mart
• Angie C Walker, MA, PPS
• Darren Walker
• Dustin Walker
• Wallace Home Medical Supplies
• Sharon Simara Wallace, HS
• Walmart Inc.
• Mary Margaret Ward, RPH
• Danielle Leigh Warren
• Eileen Warren, PH.D.

• Durable Medical Equipment & Medical Supplies in Paso Robles, CA
• Providers in Paso Robles, CA by specialty
• Durable Medical Equipment & Medical Supplies in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2013; 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.