| Dr William J Wallace, DO | |
|
146 E Hospital Dr Ste 200, West Columbia, SC 29169-4800 | |
| (803) 936-7530 | |
| (803) 936-7532 |
| Full Name | Dr William J Wallace |
|---|---|
| Gender | Male |
| Speciality | Otolaryngology |
| Experience | 34 Years |
| Location | 146 E Hospital Dr Ste 200, West Columbia, South Carolina |
| Accepts Medicare Assignments | May be. He may accept the Medicare-approved amount; you may be billed for more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275539603 | NPI | - | NPPES |
| 3306857 | Medicaid | TN | |
| 64071962 | Medicaid | KY | |
| 006500391 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Y00000X | Otolaryngology | 39895 (South Carolina) | Primary |
| 207YS0123X | Otolaryngology - Facial Plastic Surgery | 01428 (Tennessee) | Secondary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Lexington Medical Center | West columbia, SC | Hospital |
| Wellmont Holston Valley Medical Center | Kingsport, TN | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Holston Medical Group Pc | 8224935754 | 243 |
| Lexington Health Inc | 2567872070 | 906 |
| Mountain Region Speech And Hearing Center | 8628003589 | 14 |
| Mountain Region Speech And Hearing Center | 8628003589 | 14 |
| Holston Medical Group Pc | 8224935754 | 243 |
| Dominion Health And Fitness, Inc | 3274570908 | 68 |
| Dominion Health And Fitness, Inc | 3274570908 | 68 |
| Entity Name | Holston Medical Group Pc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1831110667 PECOS PAC ID: 8224935754 Enrollment ID: O20031216000416 |
| Entity Name | Meadowview Ear Nose And Throat Spec Pc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1417953845 PECOS PAC ID: 4082689401 Enrollment ID: O20040830000676 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr William J Wallace, DO Po Box 6069, West Columbia, SC 29171-6069 Ph: (803) 936-7530 | Dr William J Wallace, DO 146 E Hospital Dr Ste 200, West Columbia, SC 29169-4800 Ph: (803) 936-7530 |
Ms. Liuba Soldatova, M.D. Otolaryngology Medicare: Accepting Medicare Assignments Practice Location: 146 E Hospital Dr Ste 200, West Columbia, SC 29169 Phone: 803-936-7530 Fax: 803-936-7532 | |
Dr. William Michael Greene, M.D. Otolaryngology Medicare: Accepting Medicare Assignments Practice Location: 146 E Hospital Dr Ste 200, West Columbia, SC 29169 Phone: 803-936-7530 Fax: 803-936-7532 | |
Jordan W Rawl, M.D. Otolaryngology Medicare: Accepting Medicare Assignments Practice Location: 146 E Hospital Dr Ste 200, West Columbia, SC 29169 Phone: 803-936-7530 Fax: 803-936-7532 | |
Edward A Woody, MD Otolaryngology Medicare: Medicare Enrolled Practice Location: 146 E Hospital Dr Ste 200, West Columbia, SC 29169 Phone: 803-936-7530 Fax: 803-936-7535 | |
Neal W Burkhalter, MD Otolaryngology Medicare: Accepting Medicare Assignments Practice Location: 146 E Hospital Dr Ste 200, West Columbia, SC 29169 Phone: 803-936-7530 Fax: 803-936-7535 | |
Andrew P Battiata, MD, MS Otolaryngology Medicare: Accepting Medicare Assignments Practice Location: 146 E Hospital Dr Ste 200, West Columbia, SC 29169 Phone: 803-936-7530 Fax: 803-936-7535 |