Wallace S Wilder, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

3655 Issued in MT

Practice address

210 Sunnyview LN
Suite 103
Kalispell, MT 59901-3135

Phone

(406) 752-8300

Fax

(406) 752-3542

NPI assigned

Jul 25, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1153785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1922021518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 SUNNYVIEW LN",
            "address_2": "SUITE 103",
            "city": "KALISPELL",
            "state": "MT",
            "postal_code": "599013135",
            "telephone_number": "406-752-8300",
            "fax_number": "406-752-3542"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 SUNNYVIEW LN",
            "address_2": "SUITE 103",
            "city": "KALISPELL",
            "state": "MT",
            "postal_code": "599013135",
            "telephone_number": "406-752-8300",
            "fax_number": "406-752-3542"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILDER",
        "first_name": "WALLACE",
        "middle_name": "S",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MT",
            "license": "3655",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0032344",
            "state": "MT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "08110",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marcus Steven Wheeler, MD
• Teresa Joann Whitbey, MSW, LCSW
• Whole Health Healing LLC
• Robert L Wiedemann, D.C.
• Erika Wilcox
• Wilkes Speech Therapy, PLLC
• Sheridan Wilkes, M.S., CCC-SLP
• Neal W Wilkinson, MD
• Renee Wilkonski-Larson
• Amy B Willcoxon, PSYD

• Pediatrics Physician in Kalispell, MT
• Providers in Kalispell, MT by specialty
• Pediatrics Physician in Montana

• 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.