| Dr Edward Alton Wallace, MD | |
|
300 Singleton Ridge Rd, Conway, SC 29526-9142 | |
| (843) 669-5162 | |
| (843) 669-5162 |
| Full Name | Dr Edward Alton Wallace |
|---|---|
| Gender | Male |
| Speciality | Anesthesiology |
| Experience | 41 Years |
| Location | 300 Singleton Ridge Rd, Conway, South Carolina |
| 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 |
|---|---|---|---|
| 1255486452 | NPI | - | NPPES |
| 5900433 | Medicaid | NC | |
| 135972 | Medicaid | SC | |
| 570835798 | Other | SC | STANDARD TAX ID |
| E0051 | Other | SC | MEDCOST |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207L00000X | Anesthesiology | 13597 (South Carolina) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Mcleod Regional Medical Center-pee Dee | Florence, SC | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Mcleod Physician Associates Ii | 8224031307 | 452 |
| Entity Name | Florence Surgery & Laser Center Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1912959560 PECOS PAC ID: 0042102428 Enrollment ID: O20040416000093 |
| Entity Name | Mcleod Physician Associates Ii |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1801990494 PECOS PAC ID: 8224031307 Enrollment ID: O20060926000568 |
| Entity Name | Coastal Healthcare Resources Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1467635128 PECOS PAC ID: 1658283593 Enrollment ID: O20080225000004 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Edward Alton Wallace, MD 3100 Spring Forest Rd, Suite 130, Raleigh, NC 27616-2880 Ph: (919) 882-0705 | Dr Edward Alton Wallace, MD 300 Singleton Ridge Rd, Conway, SC 29526-9142 Ph: (843) 669-5162 |
Dr. Ihor V Melnytskyy, M.D. Anesthesiology Medicare: Accepting Medicare Assignments Practice Location: 300 Singleton Ridge Road, Conway Medical Center, Conway, SC 29526 Phone: 843-347-7111 | |
Dr. Casmir Michal Kielar, MD Anesthesiology Medicare: Not Enrolled in Medicare Practice Location: 822 Farrar Dr, Conway, SC 29526 Phone: 843-347-9587 Fax: 843-347-9633 | |
Susan J Haskin, MD Anesthesiology Medicare: Not Enrolled in Medicare Practice Location: 300 Singleton Ridge Rd, Conway, SC 29526 Phone: 843-669-5162 Fax: 843-667-4573 | |
Mr. Richard Blake Kline, MD Anesthesiology Medicare: Accepting Medicare Assignments Practice Location: 2767 Cultra Rd, Conway, SC 29526 Phone: 843-438-8470 Fax: 843-438-8480 | |
Frank F Humbles, MD Anesthesiology Medicare: Not Enrolled in Medicare Practice Location: 300 Singleton Ridge Rd, Conway, SC 29526 Phone: 843-669-5162 Fax: 843-667-4573 |