Wallace Home Medical Supplies

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

WALLACE HOME MEDICAL SUPPLIES

Doing business as

Wallace Home Medical Supplies

Practice address

12310 Los Osos Valley Rd
San Luis Obispo, CA 93405-7220

Phone

(805) 439-4007

NPI assigned

Oct 20, 2014

Organization subpart

Yes

Parent organization

WALLACE HOME MEDICAL SUPPLIESAs reported in NPPES

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

Authorized official

Name

Matthew Trago Wallace

Title

President

Phone

(805) 238-3935

Specialties & licenses 1

Addresses

Other names 1

• Wallace Home Medical Supplies Doing business as

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
  • Paso Robles, CA
  • NPI 1790947828

  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

Part of

Wallace Home Medical Supplies

Locations

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

{
    "created_epoch": "1413763200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1438819200000",
    "number": "1902200918",
    "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": "12310 LOS OSOS VALLEY RD",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934057220",
            "telephone_number": "805-439-4007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALLACE HOME MEDICAL SUPPLIES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WALLACE HOME MEDICAL SUPPLIES",
        "enumeration_date": "2014-10-20",
        "last_updated": "2015-08-06",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "TRAGO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "805-238-3935"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wallace Home Medical Supplies",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Christopher Walheim, MD
• Lydia Ann P Walker, RN
• Robin Rae Walker, LPCC14314
• Robyn Jane Walker
• Patrick Weldon Wall
• Carole Wallace
• Justin Matthew Waller, RDN
• Joseph Anthony Wallick, LVN MPH
• Nancy Walsh, MFT
• Brent Walta, M.D.

• Durable Medical Equipment & Medical Supplies in San Luis Obispo, CA
• Providers in San Luis Obispo, 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 Aug 6, 2015; 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.