Haily Wallace (NPI# 1679839534, PAC ID# 7719299338) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is FAMILY MEDICINE.
| Nation Provider ID (NPI) | 1679839534 |
| PAC ID by PECOS | 7719299338 |
| Professional Enrollment ID | I20150709002052 |
| Full Name | Haily Wallace |
| Organization Legal Name | SUNRISE MEDICAL GROUP, PC |
| Address |
117 Camino De Vida Suite 300 Santa Rosa NM 88435-2267 |
| Phone Number | 5754724311 |
| Gender | F |
| Medical School | UNIVERSITY OF NEW MEXICO SCHOOL OF MEDICINE |
| Graduation Year | 2012 |
| Primary Specialty | FAMILY MEDICINE |
| Group Practice PAC ID | 6406744028 |
| Number of Group Practice Members | 19 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 321302 | DR DAN C TRIGG MEMORIAL HOSPITAL |
| 320022 | PLAINS REGIONAL MEDICAL CENTER |
| Address | Phone | Organization |
|---|---|---|
| 117 Camino De Vida, Suite 300, Santa Rosa, NM 88435-2267 | 5754724311 | SUNRISE MEDICAL GROUP, PC |
| 301 E Miel De Luna, Dr Dan C Trigg Memorial Hospital, Tucumcari, NM 88401-3810 | 5754617000 | PRESBYTERIAN HEALTHCARE SERVICES |
| 402 E Miel De Luna, Tucumcari, NM 88401-3810 | 5754617100 | PRESBYTERIAN HEALTHCARE SERVICES |
| Organization Legal Name | SUNRISE MEDICAL GROUP, PC |
| Physicians | 19 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Sharon Cardwell | Nurse Practitioner | Sunrise Medical Group, PC | 117 Camino De Vida, Suite 300, Santa Rosa, NM 88435-2267 |
| Randal W Brown | Family Medicine | Sunrise Medical Group, PC | 220 S 3rd St, Tucumcari, NM 88401-2802 |
| Senora L Campos | Nurse Practitioner | Sunrise Medical Group, PC | 117 Camino De Vida, Suite 300, Santa Rosa, NM 88435-2267 |
| Aileen C Romero | Nurse Practitioner | Sunrise Medical Group, PC | 117 Camino De Vida, Suite 300, Santa Rosa, NM 88435-2267 |
| Mary M Kenyon | Nurse Practitioner | Sunrise Medical Group, PC | 117 Camino De Vida, Suite 300, Santa Rosa, NM 88435-2267 |
| David Neil Calkins | Anesthesiology | Sunrise Medical Group, PC | 220 S 3rd St, Tucumcari, NM 88401-2802 |
| Mark L Grossetete | Neurology | Sunrise Medical Group, PC | 117 Camino De Vida, Suite 300, Santa Rosa, NM 88435-2267 |
| Amber Nolen | Nurse Practitioner | Sunrise Medical Group, PC | 220 S 3rd St, Tucumcari, NM 88401-2802 |
| Antje Postl | Nurse Practitioner | Sunrise Medical Group, PC | 220 S 3rd St, Tucumcari, NM 88401-2802 |
| Steven T Lackey | Nurse Practitioner | Sunrise Medical Group, PC | 117 Camino De Vida, Suite 300, Santa Rosa, NM 88435-2267 |
| Street Address |
117 CAMINO DE VIDA SUITE 300 |
| City | SANTA ROSA |
| State | NM |
| Zip | 88435-2267 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Sharon Cardwell | Nurse Practitioner | Sunrise Medical Group, PC | 117 Camino De Vida, Suite 300, Santa Rosa, NM 88435-2267 |
| Senora L Campos | Nurse Practitioner | Sunrise Medical Group, PC | 117 Camino De Vida, Suite 300, Santa Rosa, NM 88435-2267 |
| Aileen C Romero | Nurse Practitioner | Sunrise Medical Group, PC | 117 Camino De Vida, Suite 300, Santa Rosa, NM 88435-2267 |
| Mary M Kenyon | Nurse Practitioner | Sunrise Medical Group, PC | 117 Camino De Vida, Suite 300, Santa Rosa, NM 88435-2267 |
| Mark L Grossetete | Neurology | Sunrise Medical Group, PC | 117 Camino De Vida, Suite 300, Santa Rosa, NM 88435-2267 |
| Steven T Lackey | Nurse Practitioner | Sunrise Medical Group, PC | 117 Camino De Vida, Suite 300, Santa Rosa, NM 88435-2267 |
| Pamela M Ammons | Nurse Practitioner | Sunrise Medical Group, PC | 117 Camino De Vida, Suite 300, Santa Rosa, NM 88435-2267 |
| James O Gonzales | Family Medicine | Sunrise Medical Group, PC | 117 Camino De Vida, Suite 300, Santa Rosa, NM 88435-2267 |
| Sally A Smith | Nurse Practitioner | Sunrise Medical Group, PC | 117 Camino De Vida, Suite 300, Santa Rosa, NM 88435-2267 |
| Chelsea A Gutierrez | Clinical Social Worker | Sunrise Medical Group, PC | 117 Camino De Vida, Suite 300, Santa Rosa, NM 88435-2267 |
| Find all physicians in the same address | |||
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Janoi Gonzalez Camejo | Nurse Practitioner | Sunrise Medical Group, PC | 117 Camino De Vida, Suite 300, Santa Rosa, NM 88435-2267 |
| Jesus Tafoya | Family Medicine | Sunrise Medical Group, PC | 117 Camino De Vida, Suite 300, Santa Rosa, NM 88435-2267 |
| Connie J Trujillo | Certified Nurse Midwife | Sunrise Medical Group, PC | 117 Camino De Vida, Suite 300, Santa Rosa, NM 88435-2267 |
| City | SANTA ROSA |
| Zip Code | 88435 |
| Specialty | FAMILY MEDICINE |
| City + Specialty | SANTA ROSA + FAMILY MEDICINE |
Please comment or provide details below to improve the information on Haily 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.