Mr Richard Jeremy Wallace, PA-C is a medicare enrolled "Physician Assistant" in Williston, South Carolina. His current practice location is
13649 Church Street, Williston, South Carolina. You can reach out to his office (for appointments etc.) via phone at
(803) 266-0060.
Mr Richard Jeremy Wallace is licensed to practice in * (Not Available) (license number ) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1841583788.
Provider's Profile
| Full Name | Mr Richard Jeremy Wallace |
|---|
| Gender | Male |
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| Speciality | Physician Assistant |
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| Location | 13649 Church Street, Williston, South Carolina |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1841583788
- Provider Enumeration Date: 05/25/2011
- Last Update Date: 01/11/2024
Medicare PECOS Information:
- PECOS PAC ID: 2365706223
- Enrollment ID: I20190409003048
Medical Identifiers
Medical identifiers for Mr Richard Jeremy Wallace such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1841583788 | NPI | - | NPPES |
| 2920 | Other | SC | MEDICAL LICENSE |
| SCE705 | Other | SC | MEDICARE |
| 3559PA | Medicaid | SC | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 363A00000X | Physician Assistant | (* (Not Available)) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mr Richard Jeremy Wallace is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Mr Richard Jeremy Wallace, PA-C
86 Wren St,
Barnwell, SC 29812-1529
Ph: (803) 259-5762 | Mr Richard Jeremy Wallace, PA-C
13649 Church Street,
Williston, SC 29853
Ph: (803) 266-0060 |
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