David Wallace (NPI# 1265743595, PAC ID# 2062727589) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is DIAGNOSTIC RADIOLOGY.
| Nation Provider ID (NPI) | 1265743595 |
| PAC ID by PECOS | 2062727589 |
| Professional Enrollment ID | I20160426000183 |
| Full Name | David Wallace |
| Organization Legal Name | SECOND AVENUE MRI LLC |
| Address |
2770 3rd Ave Suite 125 Lake Charles LA 70601-8994 |
| Phone Number | 3374942674 |
| Gender | M |
| Medical School | LOUISIANA STATE UNIVERSITY SCHOOL OF MEDICINE IN SHREVEPORT |
| Graduation Year | 2010 |
| Primary Specialty | DIAGNOSTIC RADIOLOGY |
| Group Practice PAC ID | 0749203610 |
| Number of Group Practice Members | 13 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 190027 | CHRISTUS ST PATRICK HOSPITAL |
| 190060 | LAKE CHARLES MEMORIAL HOSPITAL |
| 190013 | WEST CALCASIEU CAMERON HOSPITAL |
| 190050 | BEAUREGARD MEMORIAL HOSPITAL |
| 190201 | CHRISTUS LAKE AREA HOSPITAL |
| Address | Phone | Organization |
|---|---|---|
| 600 S Pine St, Deridder, LA 70634-4942 | 3374627100 | RADIOLOGY ASSOCIATES OF SOUTHWEST LOUISIANA |
| 1000 Walters St, Lake Charles, LA 70607-4647 | 3374758100 | RADIOLOGY ASSOCIATES OF SOUTHWEST LOUISIANA |
| 1601 Country Club Rd, Lake Charles, LA 70605-5325 | 3374397778 | RADIOLOGY ASSOCIATES OF SOUTHWEST LOUISIANA |
| 1601 Country Club Rd, Lake Charles, LA 70605-5325 | SOUTH RYAN MRI, LLC | |
| 1701 Oak Park Blvd, Lake Charles, LA 70601-8911 | RADIOLOGY ASSOCIATES OF SOUTHWEST LOUISIANA | |
| 1747 Imperial Blvd, Suite B, Lake Charles, LA 70605-5362 | 3373128284 | RADIOLOGY ASSOCIATES OF SOUTHWEST LOUISIANA |
| 1750 Ryan St, Lake Charles, LA 70601-6050 | 3374333001 | RADIOLOGY ASSOCIATES OF SOUTHWEST LOUISIANA |
| 1800 Ryan St, Suite 105, Lake Charles, LA 70601-6078 | 3374394706 | RADIOLOGY ASSOCIATES OF SOUTHWEST LOUISIANA |
| 2770 3rd Ave, Suite 125, Lake Charles, LA 70601-8994 | 3374942674 | SECOND AVENUE MRI LLC |
| 4200 Nelson Rd, Lake Charles, LA 70605-4118 | 3374746370 | RADIOLOGY ASSOCIATES OF SOUTHWEST LOUISIANA |
| 524 Doctor Michael Debakey Dr, Lake Charles, LA 70601-5725 | 3374362511 | RADIOLOGY ASSOCIATES OF SOUTHWEST LOUISIANA |
| 600 Bayou Pines E Dr, Suite A, Lake Charles, LA 70601-7194 | 3374935310 | RADIOLOGY ASSOCIATES OF SOUTHWEST LOUISIANA |
| Organization Legal Name | SECOND AVENUE MRI LLC |
| Physicians | 13 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Richard L Martinez | Diagnostic Radiology | Second Avenue Mri LLC | 2770 3rd Ave, Suite 125, Lake Charles, LA 70601-8994 |
| Donald A Woolridge | Diagnostic Radiology | Second Avenue Mri LLC | 2770 3rd Ave, Suite 125, Lake Charles, LA 70601-8994 |
| Charles J Brdlik | Diagnostic Radiology | Second Avenue Mri LLC | 2770 3rd Ave, Suite 125, Lake Charles, LA 70601-8994 |
| Adam D Olsan | Diagnostic Radiology | Second Avenue Mri LLC | 2770 3rd Ave, Suite 125, Lake Charles, LA 70601-8994 |
| Jason J Braud | Diagnostic Radiology | Second Avenue Mri LLC | 2770 3rd Ave, Suite 125, Lake Charles, LA 70601-8994 |
| Ibrahim Alshahrouri | Diagnostic Radiology | Second Avenue Mri LLC | 2770 3rd Ave, Suite 125, Lake Charles, LA 70601-8994 |
| Michael D Walker | Diagnostic Radiology | Second Avenue Mri LLC | 2770 3rd Ave, Suite 125, Lake Charles, LA 70601-8994 |
| Christopher Morgan Graham | Diagnostic Radiology | Second Avenue Mri LLC | 2770 3rd Ave, Suite 125, Lake Charles, LA 70601-8994 |
| Robert N Brown | Diagnostic Radiology | Second Avenue Mri LLC | 2770 3rd Ave, Suite 125, Lake Charles, LA 70601-8994 |
| Charles A Lim | Diagnostic Radiology | Second Avenue Mri LLC | 2770 3rd Ave, Suite 125, Lake Charles, LA 70601-8994 |
| Street Address |
2770 3RD AVE SUITE 125 |
| City | LAKE CHARLES |
| State | LA |
| Zip | 70601-8994 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Amanda E Ellington | General Surgery | Lcms Surgical Associates of Southwest Lousiana, LLC | 2770 3rd Ave, Suite 120, Lake Charles, LA 70601-7893 |
| Leroy Fredericks | Medical Oncology | Swlhs Oncology, Inc. | 2770 3rd Ave, Fl 2, Lake Charles, LA 70601-8994 |
| Richard L Martinez | Diagnostic Radiology | Second Avenue Mri LLC | 2770 3rd Ave, Suite 125, Lake Charles, LA 70601-8994 |
| Lisa Ianneillo Rubino | Nurse Practitioner | Lcms Neurosurgical Institute of Lake Charles LLC | 2770 3rd Ave, Suite 345, Lake Charles, LA 70601-8994 |
| Donald A Woolridge | Diagnostic Radiology | Second Avenue Mri LLC | 2770 3rd Ave, Suite 125, Lake Charles, LA 70601-8994 |
| Charles J Brdlik | Diagnostic Radiology | Second Avenue Mri LLC | 2770 3rd Ave, Suite 125, Lake Charles, LA 70601-8994 |
| Peter W Karam | Internal Medicine | Swlhs Inc. | 2770 3rd Ave, Suite 350, Lake Charles, LA 70601-0404 |
| Amanda V Burnett | Nurse Practitioner | Swlhs Inc. | 2770 3rd Ave, Suite 350, Lake Charles, LA 70601-0404 |
| Jennifer Taylor Graham | Nurse Practitioner | Swlhs Inc. | 2770 3rd Ave, Suite 350, Lake Charles, LA 70601-0404 |
| Adam D Olsan | Diagnostic Radiology | Second Avenue Mri LLC | 2770 3rd Ave, Suite 125, Lake Charles, LA 70601-8994 |
| Find all physicians in the same address | |||
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Nauman Qureshi | Internal Medicine | 333 Michael Debakey Dr, Suite 250, Lake Charles, LA 70601 | |
| Susan B Bourgeois Ieyoub | Internal Medicine | Swlhs Inc. | 2770 3rd Ave, Suite 350, Lake Charles, LA 70601-0404 |
| Haley Angelle Landry | Nurse Practitioner | Lcms Pulmonary Associates of Southwest Louisiana | 2770 3rd Ave, Suite 350, Lake Charles, LA 70601-0404 |
| Karie Joy Savoy | Nurse Practitioner | Swlhs Inc. | 2770 3rd Ave, Suite 350, Lake Charles, LA 70601-0404 |
| Ronald M Lewis Jr. | Internal Medicine | Swlhs Inc. | 2770 3rd Ave, Suite 350, Lake Charles, LA 70601-0404 |
| Brian D Clements | Internal Medicine | Swlhs Inc. | 2770 3rd Ave, Suite 350, Lake Charles, LA 70601-0404 |
| Cristian Romero | Internal Medicine | Swlhs Inc. | 2770 3rd Ave, Suite 350, Lake Charles, LA 70601-0404 |
| Mark David Lafuria | Internal Medicine | Swlhs Inc. | 2770 3rd Ave, Suite 350, Lake Charles, LA 70601-0404 |
| Louise M Becnel | Internal Medicine | Swlhs Inc. | 2770 3rd Ave, Suite 350, Lake Charles, LA 70601-0404 |
| William Gerard Hebert | Internal Medicine | Swlhs Inc. | 2770 3rd Ave, Suite 350, Lake Charles, LA 70601-0404 |
| Find all physicians in zip 70601 | |||
| City | LAKE CHARLES |
| Zip Code | 70601 |
| Specialty | DIAGNOSTIC RADIOLOGY |
| City + Specialty | LAKE CHARLES + DIAGNOSTIC RADIOLOGY |
Please comment or provide details below to improve the information on David Wallace.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.