WALLACE HOME MEDICAL SUPPLIES (NPI# 1902200918) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902200918 |
| Entity Type | Organization |
| Organization Name | WALLACE HOME MEDICAL SUPPLIES |
| Other Organization Name | WALLACE HOME MEDICAL SUPPLIES |
| Practice Address |
12310 Los Osos Valley Rd San Luis Obispo CA 93405-7220 |
| Mailing Address |
549 10th St Paso Robles CA 93446-2510 |
| Practice Telephone | 8054394007 |
| Mailing Telephone | 8052383935 |
| Enumeration Date | 2014-10-20 |
| Last Update Date | 2015-08-06 |
| Authorized Official Name | MATTHEW TRAGO WALLACE (PRESIDENT) |
| Authorized Official Telephone | 8052383935 |
| Is Organization Subpart | Y |
| Parent Organization Name | WALLACE HOME MEDICAL SUPPLIES |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers |
| Other Name | Type Code |
|---|---|
| Wallace Home Medical Supplies | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790947828 | Wallace Home Medical Supplies | Durable Medical Equipment & Medical Supplies | 549 10th St, Paso Robles, CA 93446-2510 | 2008-06-30 |
| 1215096466 | Wallace Home Medical Supplies | Durable Medical Equipment & Medical Supplies | 1414 Park St, Paso Robles, CA 93446-2160 | 2006-12-06 |
| Street Address |
12310 LOS OSOS VALLEY RD |
| City | SAN LUIS OBISPO |
| State | CA |
| Zip Code | 93405-7220 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164076626 | Hilary Abbott Anderson | Physician Assistant | 127 Casa St., San Luis Obispo, CA 93405 | 2019-08-01 |
| 1811465834 | Fatemeh Ladan Ahmadinia | Dentist | 764 N Santa Rosa St, San Luis Obispo, CA 93405 | 2018-11-07 |
| 1538559794 | Arnold Martin Horwitz | Marriage & Family Therapist | 1605 Garnette Drive, San Luis Obispo, CA 93405 | 2015-01-27 |
| 1750794764 | Solmaz Naghsh | Pharmacist | 765 Foothill Blvd, San Luis Obispo, CA 93405 | 2014-06-06 |
| 1609293471 | Robert S. Flores Dmd, Inc | Dentist | 878 Boysen Avenue, San Luis Obispo, CA 93405 | 2014-03-18 |
| 1457776445 | Laura Anne Wilvert | Marriage & Family Therapist | 793 E. Foothill Blvd, Suite A, #278, San Luis Obispo, CA 93405 | 2014-02-27 |
| 1497181200 | Tracey Ruby Madrigal | Counselor | 1106 Oceanaire Dr. #25, San Luis Obispo, CA 93405 | 2013-09-25 |
| 1437597572 | Sarah Michelle Brenis | Counselor | 524 Princeton Place, San Luis Obispo, CA 93405 | 2013-06-11 |
| 1013350974 | Jenna Rose Ramos | Counselor | 1459 Descanso St., San Luis Obispo, CA 93405 | 2013-04-10 |
| 1700140696 | Christopher Dieterich Marchand | Social Worker | 793a E. Foothill Blvd, 190, San Luis Obispo, CA 93405 | 2012-06-26 |
| Find all providers in zip 93405 | ||||
| Taxonomy Code | 332B00000X |
| Grouping | Suppliers |
| Classification | Durable Medical Equipment & Medical Supplies |
| A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient’s use in the home and that are usable for an extended period of time. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578181095 | Smrt LLC | Durable Medical Equipment & Medical Supplies | 1317 Broad St Ste B, San Luis Obispo, CA 93401-3909 | 2020-07-10 |
| 1104440015 | Sg Homecare, Inc | Durable Medical Equipment & Medical Supplies | 1140 Kendall Rd Ste B, San Luis Obispo, CA 93401-8047 | 2020-06-05 |
| 1558858035 | Hullander and Mozingo Lp | Durable Medical Equipment & Medical Supplies | 1551 Bishop St Ste 220, San Luis Obispo, CA 93401-4661 | 2018-04-19 |
| 1376998401 | Central Coast Home Health, Inc. | Durable Medical Equipment & Medical Supplies | 243 Granada Dr Ste A, Suite A, San Luis Obispo, CA 93401-7336 | 2016-04-26 |
| 1558778068 | Pacific Medical, Inc. | Durable Medical Equipment & Medical Supplies | 4554 Broad St, Ste 110, San Luis Obispo, CA 93401-8712 | 2014-07-16 |
| 1114211612 | Garfield Beach Cvs LLC | Durable Medical Equipment & Medical Supplies | 11990 Los Osos Valley Rd, San Luis Obispo, CA 93405-6861 | 2011-06-02 |
| 1376878215 | Sequoia Mobility, Inc. | Durable Medical Equipment & Medical Supplies | 12324 Los Osos Valley Rd, San Luis Obispo, CA 93405-7220 | 2009-10-09 |
| 1841475837 | Lifecare Solutions Inc | Durable Medical Equipment & Medical Supplies | 174 Suburban Rd Ste 100, San Luis Obispo, CA 93401 | 2008-01-08 |
| 1063583078 | Healthplus Pharmacy Inc | Durable Medical Equipment & Medical Supplies | 948 E Foothill Blvd Ste A, San Luis Obispo, CA 93405-2701 | 2006-11-13 |
| 1790886968 | Michael's Optical Inc. | Durable Medical Equipment & Medical Supplies | 719 Higuera St, San Luis Obispo, CA 93401-3512 | 2006-09-26 |
| Find all providers in SAN LUIS OBISPO | ||||
| City | SAN LUIS OBISPO |
| Zip Code | 93405 |
Please comment or provide details below to improve the information on WALLACE HOME MEDICAL SUPPLIES.
| 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.