Amanda Wallace (NPI# 1154844041, PAC ID# 2264706878) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is NURSE PRACTITIONER.
| Nation Provider ID (NPI) | 1154844041 |
| PAC ID by PECOS | 2264706878 |
| Professional Enrollment ID | I20170920003460 |
| Full Name | Amanda Wallace |
| Organization Legal Name | GEORGE CARL BORST III PSC |
| Address |
1201 Saint Christopher Dr Ashland KY 41101-7064 |
| Phone Number | 6063261101 |
| Gender | M |
| Graduation Year | 2017 |
| Primary Specialty | NURSE PRACTITIONER |
| Group Practice PAC ID | 0446245807 |
| Number of Group Practice Members | 4 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 180009 | KING'S DAUGHTERS' MEDICAL CENTER |
| Address | Phone | Organization |
|---|---|---|
| 1201 Saint Christopher Dr, Ashland, KY 41101-7064 | 6063261101 | GEORGE CARL BORST III PSC |
| Organization Legal Name | GEORGE CARL BORST III PSC |
| Physicians | 4 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| George Carl Borst | Endocrinology | George Carl Borst IIi Psc | 1201 Saint Christopher Dr, Ashland, KY 41101-7064 |
| Moussa Alhaj | Endocrinology | George Carl Borst IIi Psc | 1201 Saint Christopher Dr, Ashland, KY 41101-7064 |
| Marcella S Ramsey | Physician Assistant | George Carl Borst IIi Psc | 1201 Saint Christopher Dr, Ashland, KY 41101-7064 |
| Street Address |
1201 SAINT CHRISTOPHER DR |
| City | ASHLAND |
| State | KY |
| Zip | 41101-7064 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| George Carl Borst | Endocrinology | George Carl Borst IIi Psc | 1201 Saint Christopher Dr, Ashland, KY 41101-7064 |
| Moussa Alhaj | Endocrinology | George Carl Borst IIi Psc | 1201 Saint Christopher Dr, Ashland, KY 41101-7064 |
| Marcella S Ramsey | Physician Assistant | George Carl Borst IIi Psc | 1201 Saint Christopher Dr, Ashland, KY 41101-7064 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Timothy K Dixon | Urology | Kings Daughters Medical Specialties Inc | 336 29th St, Suite 100, Ashland, KY 41101-1900 |
| William H Boykin Jr. | Urology | Kings Daughters Medical Specialties Inc | 336 29th St, Suite 100, Ashland, KY 41101-1900 |
| Sarah Shannon | Nurse Practitioner | Fresh Start Health Psc | 336 29th St, Suite 203, Ashland, KY 41101-1932 |
| Jerrel Boyer | Neurosurgery | Fresh Start Health Psc | 336 29th St, Suite 203, Ashland, KY 41101-1932 |
| Freda Fields | Nurse Practitioner | Fresh Start Health Psc | 336 29th St, Suite 203, Ashland, KY 41101-1932 |
| Jolinda Dillow | Dermatology | 336 29th St, Suite 201, Ashland, KY 41101-1932 | |
| Patricia A Marshall | Nurse Practitioner | Bellefonte Physician Services Inc | 2930 Carter Ave, Ashland, KY 41101-1943 |
| Marcos Estrada Gomez | Rheumatology | Bellefonte Physician Services Inc | 2930 Carter Ave, Ashland, KY 41101-1943 |
| Julie Ann Estep | Nurse Practitioner | Bellefonte Physician Services Inc | 2930 Carter Ave, Ashland, KY 41101-1943 |
| Leslie L Calico | Physical Therapy | Ironton Physcial Therapy Inc | 2700 Greenup Ave, Ashland, KY 41101-1953 |
| Find all physicians in zip 41101 | |||
| City | ASHLAND |
| Zip Code | 41101 |
| Specialty | NURSE PRACTITIONER |
| City + Specialty | ASHLAND + NURSE PRACTITIONER |
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| 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.