WAL-MART STORES EAST, LP (NPI# 1104227982) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104227982 |
| Entity Type | Organization |
| Organization Name | WAL-MART STORES EAST, LP |
| Other Organization Name | WALMART CARE CLINIC 10-1339 |
| Practice Address |
10060 Two Notch Rd Columbia SC 29223-4396 |
| Mailing Address |
702 Sw 8th St Bentonville AR 72716-0445 |
| Practice Telephone | 8035676338 |
| Practice Fax Number | 8037366204 |
| Mailing Telephone | 4792048550 |
| Enumeration Date | 2014-09-11 |
| Last Update Date | 2015-02-19 |
| Authorized Official Name | LAURA LEVINE (DIRECTOR OF HEALTHCARE CONTRACTING) |
| Authorized Official Telephone | 4792048550 |
| Is Organization Subpart | Y |
| Parent Organization Name | WAL-MART STORES, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363L00000X | Nurse Practitioner | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SC | MEDICARE PTAN | D953 | 01 |
| SC | GP6567 | 05 |
| Other Name | Type Code |
|---|---|
| Walmart Care Clinic 10-1339 | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730798851 | Wal-mart Stores East, Lp | Technician/Technologist | 461 Rt 10 Suite A100, Ledgewood, NJ 07852 | 2020-07-24 |
| 1184156317 | Wal-mart Stores East, Lp | Durable Medical Equipment & Medical Supplies | 270 Heald Way, The Villages, FL 32163-6003 | 2017-03-28 |
| 1730611971 | Wal-mart Stores East, Lp | Durable Medical Equipment & Medical Supplies | 4401 Poole Rd., Raleigh, NC 27603-0000 | 2017-03-28 |
| 1720527955 | Wal-mart Stores East, Lp | Technician/Technologist | 2755 W Holton-whitehall Rd, Whitehall, MI 49461 | 2017-02-21 |
| 1003354580 | Wal-mart Stores East, Lp | Technician/Technologist | 2129 Grand Ave, Yazoo City, MS 39194 | 2017-02-06 |
| 1255874970 | Wal-mart Stores East, Lp | Technician/Technologist | 3410 Sw Market St, Lees Summit, MO 64082 | 2016-11-29 |
| 1538611066 | Wal-mart Stores East, Lp | Technician/Technologist | 546 First Colonial Road, Virginia Beach, VA 23451 | 2016-11-01 |
| 1760933196 | Wal-mart Stores East, Lp | Durable Medical Equipment & Medical Supplies | 1705 S Kings Hwy, Myrtle Beach, SC 29577-4601 | 2016-10-20 |
| 1700335312 | Wal-mart Stores East, Lp | Durable Medical Equipment & Medical Supplies | 3045 Sw Port St Lucie Blvd, Port St Lucie, FL 34953-0000 | 2016-09-23 |
| 1619425683 | Wal-mart Stores East, Lp | Technician/Technologist | 11930 Narcoossee Road, Orlando, FL 32832-0000 | 2016-09-19 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Washington State Corporations | WAL-MART STORES EAST, LP | 708 Sw 8th Street, Bentonville, AR 72716 |
| Massachusetts Corporations | WAL-MART STORES EAST, LP | 702 Sw 8th Street, Bentonville, AR 72716 |
| Oklahoma Business Registrations | WAL-MART STORES EAST, LP | 702 Sw 8th Street, Bentonville, AR 72716 |
| Oregon Corporations, Companies and Business Names | WAL-MART STORES EAST, LP, A LIMITED PARTNERSHIP OF DELAWARE | 708 Sw 8th Street, Bentonville, AR 72716 |
| Street Address |
10060 TWO NOTCH RD |
| City | COLUMBIA |
| State | SC |
| Zip Code | 29223-4396 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578500047 | Rossie Edward Watts | Optometrist | 10060 Two Notch Rd, Columbia, SC 29223-4396 | 2006-06-01 |
| 1205303583 | Lilian Funderburk | Pharmacist | 10060 Two Notch Rd, Columbia, SC 29223-4396 | 2018-10-25 |
| 1063862829 | Eric R Brinkley | Optometrist | 10060 Two Notch Rd, Columbia, SC 29223-4396 | 2016-06-13 |
| 1073912481 | Sindhu Raveendran | Pharmacist | 10060 Two Notch Rd, Columbia, SC 29223-4396 | 2014-08-21 |
| 1144638446 | Creighton Mccarley | Pharmacist | 10060 Two Notch Rd, Columbia, SC 29223-4396 | 2014-07-30 |
| 1417207713 | Focus Eye Care Center, PC | Optometrist | 10060 Two Notch Rd, Columbia, SC 29223-4396 | 2012-09-13 |
| 1285723197 | Wal-mart Stores East, Lp | Technician/Technologist | 10060 Two Notch Rd, Columbia, SC 29223-4396 | 2006-10-11 |
| 1619994878 | Wal-mart Stores East Lp | Durable Medical Equipment & Medical Supplies | 10060 Two Notch Rd, Columbia, SC 29223-4396 | 2006-07-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619522794 | Timothy Drew Edwards | Dentist | 122 N. Brickyard Rd, Columbia, SC 29223 | 2019-08-06 |
| 1861983249 | Southern Pain Specialists | Physical Medicine & Rehabilitation | 115 Blarney Dr Ste 111, Columbia, SC 29223 | 2018-05-22 |
| 1710481452 | Evans Counseling and Consulting, LLC | Social Worker | 120 Wildewood Park Dr Ste A, Columbia, SC 29223 | 2018-03-19 |
| 1750824819 | Marquita Heyward | Counselor | 1 Winsor Cove Suite 303, Columbia, SC 29223 | 2016-11-22 |
| 1578015509 | Carolina Family Pharmacy, LLC | Pharmacy | 9153 Two Notch Road, Columbia, SC 29223 | 2016-10-25 |
| 1225485170 | Lisa Diaz | Occupational Therapy Assistant | 7601 Parlane Rd, Columbia, SC 29223 | 2016-05-20 |
| 1295199859 | Sarah Ann Riley | Nurse Practitioner | Cvs Pharmacy 121 Clemson Rd., Columbia, SC 29223 | 2016-04-11 |
| 1134583214 | Sara Alisha Pound | Behavioral Analyst | 97b Winterberry Ln, Columbia, SC 29223 | 2016-04-05 |
| 1508227653 | Lucy Elvira Vicioso-harris | Counselor | 1310 Oakcrest Dr Apt 318, Columbia, SC 29223 | 2016-03-17 |
| 1134585243 | Robin Heaton | Occupational Therapy Assistant | 7601 Parklane Road, Columbia, SC 29223 | 2016-01-05 |
| Find all providers in zip 29223 | ||||
| Taxonomy Code | 363L00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. |
| Notes: Source: (1) American Nurses’ Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841806551 | Pamela Louise Smith | Nurse Practitioner | 1605 E Broadway Ste 100, Columbia, MO 65201-8023 | 2020-09-17 |
| 1518572353 | Lucretia D Sanders | Nurse Practitioner | 4201 Grand St Apt L, Columbia, SC 29203-6668 | 2020-09-09 |
| 1629698485 | Abigayle Idora Colon | Nurse Practitioner | 55 Burnett Rd, Columbia, KY 42728-9441 | 2020-04-22 |
| 1245864321 | Mh Health Care Services, PC | Nurse Practitioner | 400 Laurel St Lowr Level, Columbia, SC 29201-2281 | 2020-02-27 |
| 1649801994 | Jennifer Turner | Nurse Practitioner | 1220 Hardison Rd, Columbia, TN 38401-1350 | 2020-01-27 |
| 1700429453 | Tyease Mosley | Nurse Practitioner | 4611 Hard Scrabble Rd Ste 189, Columbia, SC 29229-8584 | 2019-10-25 |
| 1164985834 | Rameka M Reed | Nurse Practitioner | 2301 Blue Ridge Ter, Columbia, SC 29203-1303 | 2019-04-10 |
| 1366917924 | Brittney Nichole Frazier | Nurse Practitioner | 3020 Sunset Blvd West Columbia Sc 29169, Columbia, SC 29203-2920 | 2018-10-10 |
| 1295224871 | Palmetto Health - University of South Carolina Medical Group | Nurse Practitioner | 2113 Adams Grv Ste 200, Columbia, SC 29203-6957 | 2018-05-09 |
| 1730698580 | Jennifer Moon Bailey | Nurse Practitioner | 237 Longtown Rd, Columbia, SC 29229-8550 | 2017-09-25 |
| Find all providers in COLUMBIA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.