WALLACE B MCLEOD III, INC (NPI# 1194044313) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194044313 |
| Entity Type | Organization |
| Organization Name | WALLACE B MCLEOD III, INC |
| Practice Address |
2216 N Martin Luther King Ave Oklahoma City OK 73111-2445 |
| Practice Telephone | 4054240111 |
| Mailing Telephone | 4054240111 |
| Enumeration Date | 2010-05-27 |
| Last Update Date | 2010-05-27 |
| Authorized Official Name | MRS. JESSIE MAE SHAMBRA (OFFICE MANAGER) |
| Authorized Official Telephone | 4054240111 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 170100000X | Medical Genetics, Ph.D. Medical Genetics | 15393 | OK | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OK | 05538623602 | 05 |
| Street Address |
2216 N MARTIN LUTHER KING AVE |
| City | OKLAHOMA CITY |
| State | OK |
| Zip Code | 73111-2445 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922035237 | Wallace Beverly Mcleod IIi | Family Medicine | 2216 N Martin Luther King Ave, Oklahoma City, OK 73111-2404 | 2006-06-26 |
| 1861711731 | Wallace B. Mcleod IIi, Inc | Medical Genetics, Ph.D. Medical Genetics | 2216 N Martin Luther King Ave, Oklahoma City, OK 73111-2445 | 2010-05-18 |
| 1245240779 | Michael Preston Mcleod | Dentist | 2216 N Martin Luther King Ave, Oklahoma City, OK 73111-2404 | 2006-08-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689114779 | Brandi N Ridley | Counselor | 3621 N. Kelley Ave Ste. 100, Oklahoma City, OK 73111 | 2017-03-08 |
| 1790134708 | Raymond Arthur Smith Jr. | Counselor | 2329 Nw 111th, Oklahoma, OK 73111 | 2016-06-09 |
| 1124485263 | Oklahoma City County Health Department | Public Health or Welfare | 2700 Ne 63rd Street, Oklahoma City, OK 73111 | 2016-01-20 |
| 1528438710 | Brendel Lacey | Case Manager/Care Coordinator | 3017 N Martin Luther King Avenue, Oklahoma City, OK 73111 | 2015-09-30 |
| 1194108746 | Mary Margaret Mcmiller | Social Worker | 2700 Ne 63rd St, Oklahoma City, OK 73111 | 2015-07-01 |
| 1386037349 | Michelle Patrick | Counselor | 2525 Nw Expressway Suite 531, Building Up People Behavioral Health Service, Oklahoma, OK 73111 | 2015-03-13 |
| 1154764173 | Ne Wellness Community Health Clinic | Clinic/Center | 2600 Ne 63rd Street, Oklahoma City, OK 73111 | 2013-04-09 |
| 1033458070 | Mary Boyles | Case Manager/Care Coordinator | 1732 N Kelly, Oklahoma, OK 73111 | 2013-02-12 |
| 1427312164 | Sharonda Lavon Bowie | Counselor | 1328 Ne 53rd St, Oklahoma City, OK 73111 | 2012-06-27 |
| 1598029373 | Michael Brown | Counselor | 4413 Rock Island Circle, Oklahoma City, OK 73111 | 2012-06-27 |
| Find all providers in zip 73111 | ||||
| Taxonomy Code | 170100000X |
| Grouping | Other Service Providers |
| Classification | Medical Genetics, Ph.D. Medical Genetics |
| A medical geneticist works in association with a medical specialist, is affiliated with a clinical genetics program, and serves as a consultant to medical and dental specialists. |
| Notes: A general certificate was first issued by ABMS in 1982. ACGME Accredited Residency Program Requirements: None. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861711731 | Wallace B. Mcleod IIi, Inc | Medical Genetics, Ph.D. Medical Genetics | 2216 N Martin Luther King Ave, Oklahoma City, OK 73111-2445 | 2010-05-18 |
| 1639388804 | Nancy Satzler Md PC | Medical Genetics, Ph.D. Medical Genetics | 3366 Nw Expressway St, Suite 280, Oklahoma City, OK 73112-4462 | 2007-05-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205941762 | Robert Miles Chisholm IIi | Medical Genetics, Ph.D. Medical Genetics | 605 W Gore Blvd, Suite 6, Lawton, OK 73501-3727 | 2006-08-21 |
| 1306952148 | Nancy Jane Hammond | Medical Genetics, Ph.D. Medical Genetics | 6465 S Yale Ave, Suite 1010, Tulsa, OK 74136-7823 | 2006-08-22 |
| City | OKLAHOMA CITY |
| Zip Code | 73111 |
Please comment or provide details below to improve the information on WALLACE B MCLEOD III, INC.
| 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.