DR. COLLEEN MAIRE WALLACE (NPI# 1194743815) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194743815 |
| Entity Type | Individual |
| Full Name | DR. COLLEEN MAIRE WALLACE |
| Credential | MD |
| Practice Address |
1 Childrens Pl Saint Louis MO 63110-1002 |
| Mailing Address |
1 Childrens Pl Cb 8116 Saint Louis MO 63110-1002 |
| Practice Telephone | 3144542076 |
| Practice Fax Number | 3144544633 |
| Mailing Telephone | 3144542076 |
| Mailing Fax Number | 3144544633 |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2018-05-01 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208000000X | Pediatrics | 2004002778 | MO | Allopathic & Osteopathic Physicians |
| N | 2080P0204X |
Pediatrics Specialization: Pediatric Emergency Medicine |
2004002778 | MO | Allopathic & Osteopathic Physicians |
| Y | 208M00000X | Hospitalist | 2004002778 | MO | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | ENROLLED | 05 | |
| MO | 209219609 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992043210 | Colleen Therese Wallace | Skilled Nursing Facility | 9286 Arpin Richfield Rd, Arpin, WI 54410-9514 | 2013-01-21 |
| 1457964678 | Colleen R Wallace | Physical Therapist | 143 Raymond Rd, Candia, NH 03034-2133 | 2020-08-27 |
| 1255627469 | Colleen Michelle Wallace | Pediatrics | 3300 Gallows Rd, Falls Church, VA 22042-3307 | 2011-06-26 |
| 1720289580 | Colleen Carver Wallace | Social Worker | 1150 Scioto St, Urbana, OH 43078-2289 | 2007-05-30 |
| Street Address |
1 CHILDRENS PL |
| City | SAINT LOUIS |
| State | MO |
| Zip Code | 63110-1002 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669476495 | William Lee Johnson | Pediatrics | 1 Childrens Pl, Saint Louis, MO 63110-1002 | 2005-06-09 |
| 1114527033 | Kristin Kueper | Dietitian, Registered | 1 Childrens Pl, Saint Louis, MO 63110-1081 | 2020-10-29 |
| 1609474055 | Courtney Tompkins | Audiologist | 1 Childrens Pl, Saint Louis, MO 63110-1081 | 2020-10-16 |
| 1164036851 | Andrea Bumb | Nurse Practitioner | 1 Childrens Pl, Saint Louis, MO 63110-1002 | 2020-09-01 |
| 1235741513 | Shannon Ries | Nurse Practitioner | 1 Childrens Pl, Saint Louis, MO 63110-1002 | 2020-08-19 |
| 1144832320 | Lacey Bender | Nurse Practitioner | 1 Childrens Pl, Saint Louis, MO 63110-1002 | 2020-08-19 |
| 1699386417 | Kristen Bagby | Nurse Practitioner | 1 Childrens Pl, Saint Louis, MO 63110-1002 | 2020-08-14 |
| 1720696115 | Abigail Patricia Klatch | Nurse Practitioner | 1 Childrens Pl, Saint Louis, MO 63110-1002 | 2020-07-21 |
| 1518575422 | St Louis Childrens Hospital | Clinical Medical Laboratory | 1 Childrens Pl, Saint Louis, MO 63110-1002 | 2020-07-16 |
| 1730707068 | Alyssa Lavalle | Nurse Practitioner | 1 Childrens Pl, Saint Louis, MO 63110-1002 | 2020-07-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659971992 | Carrie Ellen Smith | Nurse Practitioner | Mailstop 90-00-174, One Barnes-jewish Plaza, St. Louis, MO 63110 | 2020-10-27 |
| 1881210466 | Michelle Amanda Freilich | Internal Medicine | Barnes-jewish Plaza, St. Louis, MO 63110 | 2020-06-19 |
| 1245856046 | Jeevin Shahi | Radiology | 3685 Vista Avenue, Center for Radiation Medicine, St. Louis, MO 63110 | 2020-06-18 |
| 1497371314 | Wilson Eduardo Rodriguez | Student in an Organized Health Care Education/Training Program | 1008 S. Spring, St Louis, MO 63110 | 2020-06-17 |
| 1578184065 | Kathryn Kay Lindsay | Registered Nurse | Saint Louis University Dept of Surgery, 3635 Vista Ave 3dt, St Louis, MO 63110 | 2020-05-06 |
| 1881232700 | Ashley Diane Pace | Nurse Practitioner | 1 Parkview Place, Shoenberg 6900, St. Louis, MO 63110 | 2019-12-11 |
| 1619520418 | Krithika Damodar Shenoy | Pathology | 660 Euclid Avenue, One Barnes Jewish Hospital Plaza, St. Louis, MO 63110 | 2019-07-20 |
| 1467912550 | Ian Ferguson | Dermatology | 660 S Euclid Ave., Cb 8123, St. Louis, MO 63110 | 2019-03-23 |
| 1760978688 | Ihab Hassanieh | Student in an Organized Health Care Education/Training Program | 33660 Vista Ave, St. Louis, MO 63110 | 2018-07-03 |
| 1336634500 | Martin K Mwangi | Pediatrics | 1 Childrens Place, 3s34, St. Louis, M, MO 63110 | 2018-06-28 |
| Find all providers in zip 63110 | ||||
| Taxonomy Code | 208M00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Hospitalist |
| Hospitalists are physicians whose primary professional focus is the general medical care of hospitalized patients. Their activities include patient care, teaching, research, and leadership related to Hospital Medicine. The term 'hospitalist' refers to physicians whose practice emphasizes providing care for hospitalized patients. |
| Notes: Source: American Society of Hospital Medicine, 2007. http://www.hospitalmedicine.org/ [7/1/2009: definition aded] Additional Resources: Hospitalist is a recognized fellowship specialty program offered by many medical institutions. There is no board certification for the specialty at this point. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679987481 | Ziad Sayedahmad | Hospitalist | 3635 Vista Ave Fl 13, Saint Louis, MO 63110-2539 | 2014-06-19 |
| 1063708238 | Ramya Chinnasamy | Hospitalist | 621 S New Ballas Rd Ste 112a, Saint Louis, MO 63141-8252 | 2011-06-25 |
| 1194779579 | Inpatient Consultants of Missouri Inc | Hospitalist | 12125 Woodcrest Executive Dr, Suite 220, Saint Louis, MO 63141-5001 | 2006-05-20 |
| 1457892606 | Christopher David Neal | Hospitalist | 3660 Vista Ave, Saint Louis, MO 63110-2540 | 2017-03-20 |
| 1588013726 | Matthew R Decuffa | Hospitalist | 3015 N Ballas Rd, Saint Louis, MO 63131-2329 | 2016-06-08 |
| 1407216336 | St Anthonys Physician Organization Hospitalist Services, L.c. | Hospitalist | 10010 Kennerly Rd, 3 Southbridge, Saint Louis, MO 63128-2106 | 2016-03-04 |
| 1326420522 | Ivan Nimrod Mugisha | Hospitalist | 1 Barnes Jewish Hospital Plz, Saint Louis, MO 63110-1003 | 2015-06-24 |
| 1528440161 | Wenners Ballard IIi | Hospitalist | 1 Barnes Jewish Hospital Plz, Saint Louis, MO 63110-1003 | 2015-06-19 |
| 1720460355 | Nhila Jagadeesan | Hospitalist | 1 Barnes Jewish Hospital Plz, Saint Louis, MO 63110-1003 | 2015-06-19 |
| 1427439173 | Jordan J Atkins | Hospitalist | 1 Barnes Jewish Hospital Plz, Saint Louis, MO 63110-1003 | 2015-06-17 |
| Find all providers in SAINT LOUIS | ||||
| City | SAINT LOUIS |
| Zip Code | 63110 |
Please comment or provide details below to improve the information on DR. COLLEEN MAIRE WALLACE.
| 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.