| Mr Brian David Wallace, MD | |
|
1100 Brookhaven Rd, Franklin, KY 42134-2746 | |
| (317) 614-9849 | |
| (317) 428-1044 |
| Full Name | Mr Brian David Wallace |
|---|---|
| Gender | Male |
| Speciality | Diagnostic Radiology |
| Experience | 25 Years |
| Location | 1100 Brookhaven Rd, Franklin, Kentucky |
| 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 |
|---|---|---|---|
| 1831198811 | NPI | - | NPPES |
| 64113905 | Medicaid | KY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2085R0202X | Radiology - Diagnostic Radiology | 39483 (Kentucky) | Primary |
| 2085R0202X | Radiology - Diagnostic Radiology | MD0000040992 (Tennessee) | Secondary |
| Facility Name | Location | Facility Type |
|---|---|---|
| The Medical Center (bowling Green) | Bowling green, KY | Hospital |
| The Medical Center At Franklin | Franklin, KY | Hospital |
| The Medical Center At Scottsville | Scottsville, KY | Hospital |
| Logan Memorial Hospital | Russellville, KY | Hospital |
| Caverna Memorial Hospital | Horse cave, KY | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Bowling Green-warren County Community Hospital Corporation | 7719899947 | 65 |
| Entity Name | Springfield Radiology Associates, P.c. |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1285613141 PECOS PAC ID: 8527085794 Enrollment ID: O20051027000128 |
| Entity Name | Columbus Radiology Corp |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1669408159 PECOS PAC ID: 6507754983 Enrollment ID: O20170306001343 |
| Entity Name | Bowling Green-warren County Community Hospital Corporation |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1689498107 PECOS PAC ID: 7719899947 Enrollment ID: O20250331002449 |
| Mailing Address | Practice Location Address |
|---|---|
| Mr Brian David Wallace, MD Po Box 3179, Indianapolis, IN 46206-3179 Ph: (317) 614-9849 | Mr Brian David Wallace, MD 1100 Brookhaven Rd, Franklin, KY 42134-2746 Ph: (317) 614-9849 |
Eric M Edds, MD Radiology Medicare: Accepting Medicare Assignments Practice Location: The Medical Center @ Franklin, 1100 Brookhaven Road, Franklin, KY 42134 Phone: 270-598-4800 Fax: 931-552-6663 |