| Mikaila Wallace, DO | |
|
2016 S Main St, Maryville, MO 64468-2655 | |
| (660) 562-2525 | |
| (660) 562-7996 |
| Full Name | Mikaila Wallace |
|---|---|
| Gender | Female |
| Speciality | Family Practice |
| Experience | 2 Years |
| Location | 2016 S Main St, Maryville, Missouri |
| 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 |
|---|---|---|---|
| 1023687217 | NPI | - | NPPES |
| 200147246 | Medicaid | MO | |
| 470553011-00 | Medicaid | NE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 2024030678 (Missouri) | Primary |
| 207Q00000X | Family Medicine | TEP9082 (Nebraska) | Secondary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Mosaic Life Care Home Health | Saint joseph, MO | Home health agency |
| Mosaic Life Care At St Joseph | Saint joseph, MO | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Mosaic Medical Center - Maryville | 3678813896 | 73 |
| Ssm Regional Health Services | 8921917352 | 133 |
| Entity Name | Mosaic Medical Center - Maryville |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1184189797 PECOS PAC ID: 3678813896 Enrollment ID: O20190405001537 |
| Mailing Address | Practice Location Address |
|---|---|
| Mikaila Wallace, DO 2016 S Main St, Maryville, MO 64468-2655 Ph: (660) 562-2525 | Mikaila Wallace, DO 2016 S Main St, Maryville, MO 64468-2655 Ph: (660) 562-2525 |
Dr. Sally A. Bomar, M.D. Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 2016 S Main St, Maryville, MO 64468 Phone: 660-562-2525 Fax: 660-562-4303 | |
Dr. Dallas Mullock, D.O. Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 2332 S Main St, Maryville, MO 64468 Phone: 660-562-2223 Fax: 660-562-2230 | |
Dr. Brian D. Golightly, M.D. Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 2016 S Main St, Maryville, MO 64468 Phone: 660-562-2525 Fax: 660-562-4303 | |
Charles S Fillingane Ii, DO Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 2336 S Main St Lowr Level, Maryville, MO 64468 Phone: 660-220-2123 Fax: 660-562-7911 | |
Bryan Robert Green, MD Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 2016 S Main St, Maryville, MO 64468 Phone: 660-562-7999 Fax: 660-562-7996 | |
Dr. Patrick S. Dawson, M.D. Family Medicine Medicare: Not Enrolled in Medicare Practice Location: 2016 S Main St, Maryville, MO 64468 Phone: 660-562-2525 Fax: 660-562-7993 |