| Haily Wallace, MD | |
|
402 E Miel De Luna Ave, Pmg At Dr Dan C Trigg Memorial Hospital, Tucumcari, NM 88401-3828 | |
| (575) 461-7100 | |
| (575) 461-7101 |
| Full Name | Haily Wallace |
|---|---|
| Gender | Female |
| Speciality | Family Practice |
| Experience | 13 Years |
| Location | 402 E Miel De Luna Ave, Tucumcari, New Mexico |
| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679839534 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | MD2014-0895 (New Mexico) | Primary |
| 390200000X | Student In An Organized Health Care Education/training Program | (* (Not Available)) | Secondary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Tucumcari Home Health | Tucumcari, NM | Home health agency |
| Dr Dan C Trigg Memorial Hospital | Tucumcari, NM | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Sunrise Clinics | 6800226374 | 26 |
| Presbyterian Healthcare Services | 9234041708 | 1179 |
| Entity Name | Presbyterian Healthcare Services |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1104802354 PECOS PAC ID: 9234041708 Enrollment ID: O20031103000603 |
| Entity Name | Sunrise Clinics |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1164055927 PECOS PAC ID: 6800226374 Enrollment ID: O20200423002808 |
| Mailing Address | Practice Location Address |
|---|---|
| Haily Wallace, MD Po Box 26666, Phs Provider Enrollment, Albuquerque, NM 87125-6666 Ph: (505) 923-6770 | Haily Wallace, MD 402 E Miel De Luna Ave, Pmg At Dr Dan C Trigg Memorial Hospital, Tucumcari, NM 88401-3828 Ph: (575) 461-7100 |
Mudassir Mubeen Saleemi, M.D. Family Medicine Medicare: Medicare Enrolled Practice Location: 1302 E Main St, Tucumcari, NM 88401 Phone: 505-461-2200 Fax: 505-461-2213 | |
Dr. Darrell E Willis, MD Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 402 E Miel De Luna Ave, Tucumcari, NM 88401 Phone: 575-461-7100 Fax: 575-461-7101 |