| Kara M Wallace Md Pc | |
|
4650 Whitesburg Dr Sw Suite 204 Huntsville AL 35802-1670 | |
| (256) 533-5211 | |
| (256) 533-5084 |
| Full Name | Kara M Wallace Md Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 4650 Whitesburg Dr Sw, Huntsville, Alabama |
| Authorized Official Name and Position | Karen S. Anthony (OFFICE MANAGER) |
| Authorized Official Contact | 2565335211 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kara M Wallace Md Pc 4650 Whitesburg Dr Sw Suite 204 Huntsville AL 35802-1670 Ph: (256) 533-5211 | Kara M Wallace Md Pc 4650 Whitesburg Dr Sw Suite 204 Huntsville AL 35802-1670 Ph: (256) 533-5211 |
| NPI Number | 1952377616 |
|---|---|
| Provider Enumeration Date | 02/23/2006 |
| Last Update Date | 03/24/2016 |
| Medicare PECOS PAC ID | 6608953724 |
|---|---|
| Medicare Enrollment ID | O20080414000211 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952377616 | NPI | - | NPPES |
| 051510722 | Other | AL | BLUECROSSAND BLUESHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 23260 (Alabama) | Primary |
| Provider Name | Kara M Wallace |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1487844643 PECOS PAC ID: 6800997693 Enrollment ID: I20070724000190 |
| Provider Name | Courtenay P Simmons |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174867089 PECOS PAC ID: 8820220692 Enrollment ID: I20140409001157 |
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