| Dr Philip C Wallace, MD | |
|
2115 Ne Wyatt Ct., 101, Bend, OR 97701-6324 | |
| (541) 323-6280 | |
| (541) 323-6288 |
| Full Name | Dr Philip C Wallace |
|---|---|
| Gender | Male |
| Speciality | Sports Medicine |
| Experience | 20 Years |
| Location | 2115 Ne Wyatt Ct., Bend, Oregon |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629258322 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208100000X | Physical Medicine & Rehabilitation | MD152056 (Oregon) | Primary |
| 208100000X | Physical Medicine & Rehabilitation | P1432 (Texas) | Secondary |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Central Oregon Spine And Sports Llc | 0244515641 | 3 |
| Entity Name | Northwest Medical Specialist Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1588674279 PECOS PAC ID: 3971562414 Enrollment ID: O20041008000861 |
| Entity Name | Northwest Neuro Nerve Monitoring Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1841581048 PECOS PAC ID: 9133343494 Enrollment ID: O20140607000185 |
| Entity Name | Central Oregon Spine And Sports Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1497293054 PECOS PAC ID: 0244515641 Enrollment ID: O20170328000436 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Philip C Wallace, MD 2115 Ne Wyatt Ct, Suite 101, Bend, OR 97701-7678 Ph: (541) 323-6280 | Dr Philip C Wallace, MD 2115 Ne Wyatt Ct., 101, Bend, OR 97701-6324 Ph: (541) 323-6280 |
Andrew J Fecteau, PT Physical Medicine & Rehabilitation Medicare: Not Enrolled in Medicare Practice Location: 1441swchandler Ave 104, Bend, OR 97702 Phone: 541-280-4170 | |
James O Nelson, MD Physical Medicine & Rehabilitation Medicare: Accepting Medicare Assignments Practice Location: 2200 Ne Neff Rd Ste 200, Bend, OR 97701 Phone: 541-382-3344 Fax: 541-382-1681 | |
Mathew Paluck, DO Physical Medicine & Rehabilitation Medicare: Accepting Medicare Assignments Practice Location: 2200 Ne Neff Rd Ste 200, Bend, OR 97701 Phone: 541-382-3344 Fax: 541-382-1681 | |
Kari Lindegren, PT, DPT Physical Medicine & Rehabilitation Medicare: Not Enrolled in Medicare Practice Location: 1476 Ne Mable Ct, Bend, OR 97701 Phone: 949-212-2058 | |
Lewis Brian Barnett, D.O. Physical Medicine & Rehabilitation Medicare: Accepting Medicare Assignments Practice Location: 1501 Ne Medical Center Dr, Bend, OR 97701 Phone: 541-382-4900 Fax: 541-706-2398 | |
Bessie Joy Perkey, M.D. Physical Medicine & Rehabilitation Medicare: Accepting Medicare Assignments Practice Location: 2200 Ne Neff Rd Ste 200, Bend, OR 97701 Phone: 541-382-3344 | |
Viviane Ugalde, MD Physical Medicine & Rehabilitation Medicare: Medicare Enrolled Practice Location: 2200 Ne Neff Rd, Ste 200, Bend, OR 97701 Phone: 541-382-3344 Fax: 541-382-1681 |