Thomas K Wallace, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

R 132463-3 Issued in MN

Practice address

800 E 28TH St
Minneapolis, MN 55407-3723

Phone

(612) 871-7639

Fax

(612) 872-0302

NPI assigned

Sep 28, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Central Minnesota Anesthesia Providers, PA

  • Certified Registered Nurse Anesthetist
  • Becker, MN
  • NPI 1881689974

  Nurse Anesthetist, Certified Registered

  NPD
• Metropolitan Anesthesia Network, LLP

  • Anesthesiology Physician
  • Plymouth, MN
  • NPI 1558314427

  Nurse Anesthetist, Certified Registered

  NPD

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

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1811089006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2545 CHICAGO AVE",
            "address_2": "SUITE 311",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554044522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 E 28TH ST",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554073723",
            "telephone_number": "612-871-7639",
            "fax_number": "612-872-0302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "THOMAS",
        "middle_name": "K",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MN",
            "license": "R 132463-3",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CRNA CERTIFICATION",
            "identifier": "075748",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Hannah Wallace
• James Wallace, M.D.
• Meghan Wallace, OT
• Peter Allan Wallace
• Simone Wallace
• Willie Wallace
• Jeff Wallager
• Nancy Waller, M.D.
• Jason Owen Wallin, DC
• Wallingburg Home Care Services

• Certified Registered Nurse Anesthetist in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Certified Registered Nurse Anesthetist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.