| Allen Wallace, CRNA | |
|
250 W 300 N, Roosevelt, UT 84066-2336 | |
| (435) 722-6163 | |
| (435) 722-9291 |
| Full Name | Allen Wallace |
|---|---|
| Gender | Male |
| Speciality | Certified Registered Nurse Anesthetist (crna) |
| Experience | 32 Years |
| Location | 250 W 300 N, Roosevelt, Utah |
| 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 |
|---|---|---|---|
| 1295798163 | NPI | - | NPPES |
| D0808 | Medicaid | UT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 367500000X | Nurse Anesthetist, Certified Registered | 192839-4406 (Utah) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Uintah Basin Medical Center | Roosevelt, UT | Hospital |
| Entity Name | Uintah Basin Medical Center Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1871556217 PECOS PAC ID: 0244131944 Enrollment ID: O20040226000948 |
| Entity Name | Ubmc Anesthesiology |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1043643877 PECOS PAC ID: 4981833381 Enrollment ID: O20140205001393 |
| Mailing Address | Practice Location Address |
|---|---|
| Allen Wallace, CRNA 250 W 300 N, Roosevelt, UT 84066-2336 Ph: (435) 722-6163 | Allen Wallace, CRNA 250 W 300 N, Roosevelt, UT 84066-2336 Ph: (435) 722-6163 |
Lucas C Reichert, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 1126 W Grayhawk Loop, Roosevelt, UT 84066 Phone: 207-659-8756 | |
Trent Bell, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 250 W 300 N, Roosevelt, UT 84066 Phone: 435-722-6163 Fax: 435-722-9291 | |
Frank Guercio, CRNA Nurse Anesthetist - CR Medicare: Not Enrolled in Medicare Practice Location: 250 W 300 N, Roosevelt, UT 84066 Phone: 435-722-6163 Fax: 435-722-9291 | |
Steven R Knight, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 250 W 300 N, Roosevelt, UT 84066 Phone: 435-722-6163 Fax: 435-722-9291 |