AMANDA FRASER WALLACE (NPI# 1174750707) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1174750707 |
Entity Type | Individual |
Full Name | AMANDA FRASER WALLACE |
Credential | MD |
Practice Address |
755 Heritage Rd Golden CO 80401-3600 |
Mailing Address |
1818 E 7th Ave Denver CO 80218-3645 |
Practice Telephone | 3032770700 |
Enumeration Date | 2009-06-22 |
Last Update Date | 2019-01-07 |
Gender Code | F |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 207L00000X | Anesthesiology | DR0052096 | CO | Allopathic & Osteopathic Physicians |
Y | 207LP2900X |
Anesthesiology Specialization: Pain Medicine |
0052096 | CO | Allopathic & Osteopathic Physicians |
Address | Telephone Number | Fax Number |
---|---|---|
888 S Auto Mall Rd, Bloomington, IN 474015430 | 8123532700 | 8123532701 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1518249838 | Amanda Daniel Wallace | Physician Assistant | 655 Jesse Jewell Pkwy Se Ste B, Gainesville, GA 30501-3854 | 2011-09-13 |
1366635245 | Amanda Wallace | Counselor | 1907 Kristy Ct, Longmont, CO 80504-7387 | 2007-08-23 |
1952808024 | Amanda Marie Wallace | Case Manager/Care Coordinator | 205 Main St E, Mohall, ND 58761-4014 | 2018-04-06 |
1306345848 | Amanda Cheyenne Wallace | Student in an Organized Health Care Education/Training Program | 3640 Colonel Glenn Hwy, Dayton, OH 45435-0001 | 2018-02-11 |
1972015659 | Amanda Wallace | Behavior Technician | 41521 W 11 Mile Rd, Novi, MI 48375-1803 | 2017-11-02 |
1154844041 | Amanda Gail Wallace | Nurse Practitioner | 142 Depot Dr, South Shore, KY 41175-9306 | 2017-07-21 |
1578097341 | Amanda Wallace | Physical Therapist | 2115 Dulles Dr, Lafayette, LA 70506-2652 | 2017-04-18 |
1649665977 | Amanda Rose Wallace | Psychiatry & Neurology | 525 E 68th St, New York, NY 10065 | 2015-04-03 |
1972908010 | Amanda Jo Wallace | Psychologist | 1500 N Westwood Blvd, Poplar Bluff, MO 63901-3318 | 2014-10-31 |
1578964888 | Amanda Leigh Wallace | Speech-Language Pathologist | 928 W Market St, Tiffin, OH 44883-2529 | 2014-09-07 |
Street Address |
755 HERITAGE RD |
City | GOLDEN |
State | CO |
Zip Code | 80401-3600 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1245282862 | Robert Z Moghim | Anesthesiology | 755 Heritage Rd, Suite 100, Golden, CO 80401-3600 | 2006-05-16 |
1063943611 | Hortense Mbwenze Ngoe | Nurse Practitioner | 755 Heritage Rd, Ste 100, Golden, CO 80401-3600 | 2017-03-24 |
1982062337 | Emmanuela Agwu | Nurse Practitioner | 755 Heritage Rd, Ste 100, Golden, CO 80401-3600 | 2016-01-31 |
1073986980 | Rachael Passafaro | Physician Assistant | 755 Heritage Rd, Suite 100, Golden, CO 80401-3600 | 2015-11-02 |
1619344066 | Arizona Pain Specialists, Pllc | Anesthesiology | 755 Heritage Rd, Suite 100, Golden, CO 80401-3600 | 2015-09-01 |
1528400082 | Colorado Pain Care, LLC | Anesthesiology | 755 Heritage Rd, Suite 100, Golden, CO 80401-3600 | 2013-07-25 |
1962796342 | Ajay Rajkumar Vellore | Anesthesiology | 755 Heritage Rd, Suite 100, Golden, CO 80401-3600 | 2011-06-03 |
1134331101 | Jordanna Quinn | Physical Medicine & Rehabilitation | 755 Heritage Rd, Suite 100, Golden, CO 80401-3600 | 2007-05-04 |
1881726891 | Red Rocks Center for Rehabilitation | Specialist | 755 Heritage Rd, Sutie 100, Golden, CO 80401-3600 | 2007-03-12 |
1124107909 | Jeffrey Kesten | Physical Medicine & Rehabilitation | 755 Heritage Rd, #100, Golden, CO 80401-3600 | 2006-11-03 |
Find all providers in the same location |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1093315152 | Ruth Lucia Settak | Social Worker | 17301 W. Colfax Ave., Ste 200, Golden, CO 80401 | 2020-10-28 |
1811457088 | Evening Elegance LLC | Prosthetic/Orthotic Supplier | 14500 W Colfax Ave Unit 246, Lakewood, CO 80401 | 2019-03-22 |
1255853826 | Angela Kathryn Brickman | Behavior Technician | 714 Ridgeside Drive, Golden, CO 80401 | 2017-07-14 |
1710408240 | Catherine Camacho | Psychologist | 913 Arapahoe St, Golden, CO 80401 | 2017-07-06 |
1710420492 | Colorado Complete Urgent Care Physicians LLC | Clinic/Center | 17101 S Golden Rd., Golden, CO 80401 | 2016-11-29 |
1366991051 | Britta Marie Olson | Physical Therapist | 600 Golden Ridge Rd, Suite 130, Golden, CO 80401 | 2016-09-23 |
1003284209 | Maria Alta Mcvey | Dental Hygienist | 2305 Jackson St., Golden, CO 80401 | 2015-09-04 |
1548644479 | Christine Rodriguez | Dental Hygienist | 2305 Jackson Street, Golden, CO 80401 | 2015-07-09 |
1508285776 | Colorado Pain Practice, Pllc | Anesthesiology | 755 Heritage Road, Suite 100, Golden, CO 80401 | 2014-04-15 |
1942644844 | Golden Kids Dental | Dentist | 2421 Ford St., Golden, CO 80401 | 2013-04-22 |
Find all providers in zip 80401 |
Taxonomy Code | 207LP2900X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Anesthesiology |
Specialization | Pain Medicine |
An anesthesiologist who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chronic and/or cancer pain in both hospital and ambulatory settings. Patient care needs are also coordinated with other specialists. |
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Anesthesiology, 2007. http://www.theaba.org/; American Osteopathic Board of Anesthesiology, 2007, http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Anesthesiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Anesthesiology. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1508285776 | Colorado Pain Practice, Pllc | Anesthesiology | 755 Heritage Road, Suite 100, Golden, CO 80401 | 2014-04-15 |
1932387966 | Daniel Alan Drennan | Anesthesiology | 400 Indiana St Ste 320, Golden, CO 80401-5033 | 2008-01-31 |
1245282862 | Robert Z Moghim | Anesthesiology | 755 Heritage Rd, Suite 100, Golden, CO 80401-3600 | 2006-05-16 |
1619344066 | Arizona Pain Specialists, Pllc | Anesthesiology | 755 Heritage Rd, Suite 100, Golden, CO 80401-3600 | 2015-09-01 |
1447631361 | Andrew J Wendahl | Anesthesiology | 400 Indiana St Ste 320, Golden, CO 80401-5033 | 2015-06-16 |
1528400082 | Colorado Pain Care, LLC | Anesthesiology | 755 Heritage Rd, Suite 100, Golden, CO 80401-3600 | 2013-07-25 |
1457600231 | Daniel S Bennett Md PC | Anesthesiology | 14828 W 6th Ave, Ste 16-b, Golden, CO 80401-5000 | 2012-09-07 |
1447496377 | Ambulatory Anesthesia Consultants PC | Anesthesiology | 1819 Denver West Dr, Suite 200, Golden, CO 80401-3118 | 2008-12-24 |
1902999352 | Jason Krutsch | Anesthesiology | 755 Heritage Rd, #100, Golden, CO 80401-3600 | 2006-09-30 |
1255355467 | Daniel S Bennett | Anesthesiology | 14828 W 6th Ave, Ste 16-b, Golden, CO 80401-5000 | 2006-07-27 |
Find all providers in GOLDEN |
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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.