WALLACE LYLE PAST SR. (NPI# 1871868802) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871868802 |
| Entity Type | Individual |
| Full Name | WALLACE LYLE PAST SR. |
| Credential | M.D. |
| Practice Address |
4608 Heritage Manor Crestwood KY 40014 |
| Practice Telephone | 5026146688 |
| Practice Fax Number | 5026146688 |
| Mailing Telephone | 5026146688 |
| Mailing Fax Number | 5026146688 |
| Enumeration Date | 2012-03-08 |
| Last Update Date | 2012-03-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208D00000X | General Practice | 01018231A | IN | Allopathic & Osteopathic Physicians |
| Street Address |
4608 HERITAGE MANOR |
| City | CRESTWOOD |
| State | KY |
| Zip Code | 40014 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720411556 | Meagan L Vowels | Behavioral Analyst | 5895 W. Hwy 146, Crestwood, KY 40014 | 2013-08-15 |
| 1003157538 | Craig L Satterley | Physical Therapist | 6003 Pleasant Colony Ct Ste 3, Crestwood, KY 40014 | 2013-03-07 |
| 1609153725 | Patricia Ann Gray | Behavioral Analyst | 5895 W Highway 146, Crestwood, KY 40014 | 2011-11-03 |
| 1528374253 | Laura R Carroll | Dentist | 6344 W. Hwy 146 Ste 100, Crestwood, KY 40014 | 2010-08-18 |
| 1699922849 | Mortenson Family Dental Center | Clinic/Center | 6408 W Hwy 146, Crestwood, KY 40014 | 2008-08-19 |
| 1760658546 | Kathy J. Pansegrau, Dc, Psc | Chiropractor | 6402 Westwind Way, Suite 5, Crestwood, KY 40014 | 2008-05-01 |
| 1952584054 | Alyssa Ann Dykgraaf | Dentist | 5805 Whwy 22, Ste 100, Crestwood, KY 40014 | 2007-12-11 |
| 1780881649 | Gwinn A. K. Vonnahme | Dentist | 5998 Pleasant Colony Ct. Suite 23, Crestwood, KY 40014 | 2007-07-02 |
| 1326250960 | Sue B Feeley | Dentist | 6225 W Hwy 146, Crestwood, KY 40014 | 2007-05-04 |
| 1356553424 | Abundant Solutions, LLC | Occupational Therapy Assistant | 2212 Outer Circle Drive, Crestwood, KY 40014 | 2007-05-03 |
| Find all providers in zip 40014 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932264868 | Ashok Alur | General Practice | 6520 W Hwy 22, Crestwood, KY 40014 | 2006-12-22 |
| 1922142983 | South Oldham Medical Clinic Psc | General Practice | 6520 W Hwy 22, Crestwood, KY 40014 | 2007-02-16 |
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| 1760979124 | Healthy Living Primary Care | General Practice | 4400 Breckenridge Ln Ste 147, Louisville, KY 40218 | 2018-04-20 |
| 1649775586 | Landmark Medical of Kentucky, Psc | General Practice | 113 Glenn Pl Unit 100, Lexington, KY 40505-3518 | 2018-03-23 |
| 1639603145 | Charita Weathers | General Practice | 401 East Chestnut, Ste 610, Louisville, KY 40202 | 2017-04-12 |
| 1881146033 | Alliance Health Care, LLC | General Practice | 1710 D State Route 121 North, Murray, KY 42071 | 2016-11-03 |
| 1528519113 | A New Journey | General Practice | 4100 Cadillac Ct, Louisville, KY 40213-1591 | 2016-10-18 |
| 1013381441 | Veloz Medical Services Corp | General Practice | 6911 Shepherdsville Rd, Louisville, KY 40219-2211 | 2015-11-23 |
| 1407229545 | Fern Medical and Rehab Corp | General Practice | 5520 Fern Valley Rd, 107, Louisville, KY 40228-1087 | 2015-11-12 |
| Find all providers with the same taxonomy | ||||
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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.