Jeanne B Wallace (NPI# 1164408043, PAC ID# 5991695074) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is ANESTHESIOLOGY.
Nation Provider ID (NPI) | 1164408043 |
PAC ID by PECOS | 5991695074 |
Professional Enrollment ID | I20040319001433 |
Full Name | Jeanne B Wallace |
Organization Legal Name | CHAMPION ANESTHESIA CONSULTANTS PLLC |
Address |
1545 E Southlake Blvd Southlake TX 76092-6422 |
Phone Number | 8177488700 |
Gender | F |
Credential | MD |
Graduation Year | 1983 |
Primary Specialty | ANESTHESIOLOGY |
Group Practice PAC ID | 7113231358 |
Number of Group Practice Members | 18 |
Accepts Medicare Assignment | Y |
Claim Control Number (CCN) | Legal Business Name |
---|---|
450883 | BAYLOR MEDICAL CENTER AT TROPHY CLUB |
Address | Phone | Organization |
---|---|---|
1545 E Southlake Blvd, Southlake, TX 76092-6422 | 8177488700 | CHAMPION ANESTHESIA CONSULTANTS PLLC |
Organization Legal Name | CHAMPION ANESTHESIA CONSULTANTS PLLC |
Physicians | 12 |
Name | Specialty | Organization | Address |
---|---|---|---|
Lisa C Chenault | Certified Registered Nurse Anesthetist (crna) | Champion Anesthesia Consultants Pllc | 2850 E State Hwy 114, Trophy Club, TX 76262-5302 |
Gregory B Gaskin Ii | Anesthesiology | Champion Anesthesia Consultants Pllc | 415 E Southlake Blvd, Suite 202, Southlake, TX 76092-6280 |
Michael L Gibson | Anesthesiology | Champion Anesthesia Consultants Pllc | 2600 W Pleasant Run Rd, Lancaster, TX 75146-1114 |
Christine C Wyrick | Anesthesiology | Champion Anesthesia Consultants Pllc | 1400 8th Ave, Fort Worth, TX 76104-4110 |
David B Serota | Anesthesiology | Champion Anesthesia Consultants Pllc | 2600 W Pleasant Run Rd, Lancaster, TX 75146-1114 |
Jonathon S Scarborough | Certified Registered Nurse Anesthetist (crna) | Champion Anesthesia Consultants Pllc | 415 E Southlake Blvd, Suite 202, Southlake, TX 76092-6280 |
Timothy T Tye | Anesthesiology | Champion Anesthesia Consultants Pllc | 11970 N Central Expy, Suite 610, Dallas, TX 75243-3768 |
Robert M Lagon | Anesthesiology | Champion Anesthesia Consultants Pllc | 1351 W President George Bush Hwy, Richardson, TX 75080-1133 |
Joseph V Nicolosi | Anesthesiology | Champion Anesthesia Consultants Pllc | 2850 E State Hwy 114, Trophy Club, TX 76262-5302 |
John L Thorne | Anesthesiology | Champion Anesthesia Consultants Pllc | 11990 N Central Expressway, Dallas, TX 75243-3714 |
Street Address |
1545 E SOUTHLAKE BLVD |
City | SOUTHLAKE |
State | TX |
Zip | 76092-6422 |
Name | Specialty | Organization | Address |
---|---|---|---|
Maria Valeria Simone | General Surgery | 1545 E Southlake Blvd, Suite 140, Southlake, TX 76092-6464 | |
Peter C Kwong | Orthopedic Surgery | 1545 E Southlake Blvd, Suite 270, Southlake, TX 76092-5564 | |
Gayle M Jasinski | Physician Assistant | Texas Health Back Care | 1545 E Southlake Blvd, Southlake, TX 76092-6422 |
Peter J Gootos | Anesthesiology | U S Anesthesia Partners of Texas, Pa | 1545 E Southlake Blvd, Southlake, TX 76092-6422 |
Theresa Menditto | Physical Therapy | Texas Health Back Care | 1545 E Southlake Blvd, Suite 100, Southlake, TX 76092-6465 |
Tristan Boyd | Physical Therapy | Texas Health Back Care | 1545 E Southlake Blvd, Suite 100, Southlake, TX 76092-6465 |
Frederic James Hwang | Anesthesiology | U S Anesthesia Partners of Texas, Pa | 1545 E Southlake Blvd, Southlake, TX 76092-6422 |
Elizabeth Chandy | Internal Medicine | 1545 E Southlake Blvd, Southlake, TX 76092-6422 | |
David S Ackerman | Anesthesiology | U S Anesthesia Partners of Texas, Pa | 1545 E Southlake Blvd, Southlake, TX 76092-6422 |
Paul Y Youn | Anesthesiology | U S Anesthesia Partners of Texas, Pa | 1545 E Southlake Blvd, Southlake, TX 76092-6422 |
Find all physicians in the same address |
Name | Specialty | Organization | Address |
---|---|---|---|
Carol A Marsh | Optometry | Marsh Eye Center Inc | Marsh Eye Ctr, 670 East Southlake Blvd, Southlake, TX 76092 |
Branon Z Marsh | Optometry | Marsh Eye Center Inc | Marsh Eye Ctr, 670 East Southlake Blvd, Southlake, TX 76092 |
Jerry L Lugger | Plastic and Reconstructive Surgery | 3061 W Southlake Blvd, Suite 130, Southlake, TX 76092-0311 | |
Deborah J Zanella | Optometry | Zanella Optometry, Pllc | 2111 E Kirkwood Blvd, 100 Kirkwood Eye Center, Southlake, TX 76092-1441 |
Alex R Conley | Optometry | Zanella Optometry, Pllc | 2111 E Kirkwood Blvd, 100 Kirkwood Eye Center, Southlake, TX 76092-1441 |
Taylor R Brooks | Optometry | Zanella Optometry, Pllc | 2111 E Kirkwood Blvd, 100 Kirkwood Eye Center, Southlake, TX 76092-1441 |
Peter J Zanella Jr. | Optometry | Zanella Optometry, Pllc | 2111 E Kirkwood Blvd, 100 Kirkwood Eye Center, Southlake, TX 76092-1441 |
Rawn E Bosley | Dermatology | 925 E Southlake Blvd, Suite 200, Southlake, TX 76092-1476 | |
Victoria A Lopez | Physical Therapy | Ideal Physical Therapy of Texas LLC | 245 W State Hwy 114, Suite 320, Southlake, TX 76092-3603 |
Asif Husain | General Surgery | 190 W State Hwy 114, Suite G, Southlake, TX 76092-3612 | |
Find all physicians in zip 76092 |
City | SOUTHLAKE |
Zip Code | 76092 |
Specialty | ANESTHESIOLOGY |
City + Specialty | SOUTHLAKE + ANESTHESIOLOGY |
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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.