JOHN WALLACE SR. (NPI# 1316926066) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316926066 |
| Entity Type | Individual |
| Full Name | JOHN WALLACE SR. |
| Credential | IDC |
| Practice Address |
300 E Main St Suite 1000 Norfolk VA 23510-1753 |
| Mailing Address |
235 Jonathans Way Suffolk VA 23434-9153 |
| Practice Telephone | 7576284347 |
| Mailing Telephone | 7579233793 |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | X |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1710I1002X |
Military Health Care Provider Specialization: Independent Duty Corpsman |
Other Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023508868 | John E Wallace | Physical Therapist | 1060 Nimitzview Dr Ste 205, Cincinnati, OH 45230-4351 | 2018-05-17 |
| 1679900161 | John D Wallace | Counselor | 1455 Nw 53rd St Apt 222, Miami, FL 33142 | 2013-09-30 |
| 1437590973 | John Burton Wallace V | Social Worker | 141 S 5th St Ofc East, Brooklyn, NY 11211 | 2013-07-12 |
| 1346517307 | John Widtsoe Wallace | Specialist | 1091 Southport Dr, Medina, OH 44256-3019 | 2011-11-18 |
| 1225292634 | John Wallace | Anesthesiology | 3420 S Mercy Rd Ste 200, Gilbert, AZ 85297-0423 | 2008-07-15 |
| 1629241070 | John Dean Wallace Jr. | Dentist | 9913 Mission Gorge Rd Unit 1, Santee, CA 92071-3843 | 2008-04-08 |
| 1275663916 | John Robert Wallace | Physical Therapist | 103 W Woodhill Dr, Suite A, Nags Head, NC 27959 | 2007-03-06 |
| 1346379161 | John G Wallace | Psychiatry & Neurology | 17515 N Park Pl N, Shoreline, WA 98133-4803 | 2007-03-05 |
| 1841359775 | John Thomas Wallace | Chiropractor | 3314 Us Highway 431, Albertville, AL 35950 | 2006-12-06 |
| 1316038839 | John Kline Wallace | Dentist | 2501 Princess Anne St, Fredericksburg, VA 22401-3333 | 2006-09-28 |
| Street Address |
300 E MAIN ST SUITE 1000 |
| City | NORFOLK |
| State | VA |
| Zip Code | 23510-1753 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992783690 | Thomas James Lavey | Emergency Medical Technician, Paramedic | 300 E Main St, Suite #1000, Norfolk, VA 23510-1753 | 2006-01-04 |
| 1851828321 | Uscg Clinic Savannah | Clinic/Center | 300 E Main St, Norfolk, VA 23510-1753 | 2017-05-16 |
| 1194252668 | Uscg Clinic Barbers Point | Clinic/Center | 300 E Main St, Norfolk, VA 23510-1753 | 2017-05-16 |
| 1659808269 | Uscg Clinic Corpus Christi | Clinic/Center | 300 E Main St, Norfolk, VA 23510-1753 | 2017-05-12 |
| 1982130704 | Uscg Clinic Jacksonville | Clinic/Center | 300 E Main St, Norfolk, VA 23510-1753 | 2017-05-11 |
| 1336327394 | Ivan Enrique Castro | Emergency Medical Technician, Basic | 300 E Main St, Norfolk, VA 23510-1753 | 2008-02-01 |
| 1609938299 | Neftali Nathanael Ramirez | Technician, Other | 300 E Main St, Suite 1000, Norfolk, VA 23510-1753 | 2006-12-14 |
| 1285795096 | Jay Andrew Wood | Technician, Other | 300 E Main St, Norfolk, VA 23510-1753 | 2006-12-13 |
| 1720149560 | David Paul Lehmkuhl | Technician, Other | 300 E Main St, Suite 1000, Norfolk, VA 23510-1753 | 2006-12-13 |
| 1154482917 | Howard R. Harris | Technician, Other | 300 E Main St, Suite 1000, Norfolk, VA 23510-1753 | 2006-12-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972151108 | Brittany Delong | Speech-Language Pathologist | 534 E Olney Road, Norfolk, VA 23510 | 2019-08-30 |
| 1881164366 | Gregory D Newman | Hearing Instrument Specialist | 501 B Bousch St, Norfolk, VA 23510 | 2018-11-28 |
| 1598282998 | Tidewater Hyperbaric | Preventive Medicine | 129 West Virginia Beach Blvd, Suite 140 A, Norfolk, VA 23510 | 2017-08-25 |
| 1295276186 | John Michael Curnes | General Practice | 200 College Pl Apt 215, Norfolk, VA 23510 | 2017-03-13 |
| 1326499989 | East Coast Family Services | Community/Behavioral Health | 259 Granby St., Norfolk, VA 23510 | 2016-06-24 |
| 1659750529 | Cortney Armitano | Specialist/Technologist | 201 West Tazewell Street, Apt. 206, Norfolk, VA 23510 | 2015-05-26 |
| 1285076067 | Abundant Life Therapeutic Services LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 645 Church St., Suite 104c, Norfolk, VA 23510 | 2013-07-22 |
| 1497196901 | Patricia Ann Richardson | Assisted Living Facility | 101 East Plume Street, 501, Norfolk, VA 23510 | 2013-07-12 |
| 1427319300 | The Foleck Center | Dentist | 201 College Place, #111, Norfolk, VA 23510 | 2012-06-06 |
| 1033414941 | Laura Jeanne O'neal | Social Worker | 250 W Brambleton Ave, Ste 101, Norfolk, VA 23510 | 2011-01-24 |
| Find all providers in zip 23510 | ||||
| Taxonomy Code | 1710I1002X |
| Grouping | Other Service Providers |
| Classification | Military Health Care Provider |
| Specialization | Independent Duty Corpsman |
| A Navy Independent Duty Corpsman (IDC) is an active duty Sailor who has successfully completed one of the Navy's specific IDC training programs. IDCs are formally trained and educated to perform primary medical care and minor surgical services in a variety of health care and non-health care settings worldwide under indirect physician supervision. IDCs provide care to Department of Defense operational forces and other supporting forces such as contractors and foreign nationals. |
| Notes: Source: Bureau of Medicine and Surgery, Department of the Navy [7/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447814090 | Francis Anthony Edquid | Military Health Care Provider | 9560 Farragut Ave, Norfolk, VA 23511-2715 | 2019-04-30 |
| 1215591888 | Nash Richard Galvan | Military Health Care Provider | 456-462 Pocahontas St, Norfolk, VA 23511 | 2019-04-29 |
| 1841694684 | Andre Huggins | Military Health Care Provider | 1687 Pocahontas St, Bldg 1a, Norfolk, VA 23511-2918 | 2014-10-21 |
| 1861753030 | Spencer Grey | Military Health Care Provider | 334 E Evans St, Norfolk, VA 23503-5213 | 2012-06-05 |
| 1508155375 | Leonard B Gordon | Military Health Care Provider | Comnavsurflant N02m, 1430 Mitscher Ave, Norfolk, VA 23551-2494 | 2011-04-01 |
| 1073812095 | Eric William Staley | Military Health Care Provider | 7958 Blandy Road, Commander Submarine Force Atlantic, Norfolk, VA 23551-2492 | 2011-03-16 |
| 1497051460 | Mitchell Todd Pearce | Military Health Care Provider | 1004 Hermitage Rd., Norfolk, VA 23521-5000 | 2011-02-08 |
| 1003119538 | Shayla R Robertson | Military Health Care Provider | 150 Allen St, Norfolk, VA 23505-1373 | 2010-12-05 |
| 1053629964 | Shawnly Heath Ward | Military Health Care Provider | Surface Warfare Medical Institute - East, 459 Bellinger Blvd, Norfolk, VA 23511 | 2010-09-14 |
| 1225351760 | Jocelyn Martinezdelgado | Military Health Care Provider | 8857 1st Street, Pcu Jason Dunham Suite 400, Norfolk, VA 23511 | 2010-03-11 |
| Find all providers in NORFOLK | ||||
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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.