| Wallace Family Practice PA | |
|
3400 Lee Blvd Suite 108 Lehigh Acres FL 33971-1309 | |
| (239) 369-2903 | |
| (239) 369-0500 |
| Full Name | Wallace Family Practice PA |
|---|---|
| Speciality | Clinic/Center |
| Location | 3400 Lee Blvd, Lehigh Acres, Florida |
| Authorized Official Name and Position | Tasha B. Wallace (PRESIDENT) |
| Authorized Official Contact | 2393692903 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wallace Family Practice PA 3400 Lee Blvd Suite 108 Lehigh Acres FL 33971-1309 Ph: (239) 369-2903 | Wallace Family Practice PA 3400 Lee Blvd Suite 108 Lehigh Acres FL 33971-1309 Ph: (239) 369-2903 |
| NPI Number | 1063548410 |
|---|---|
| Provider Enumeration Date | 02/27/2007 |
| Last Update Date | 12/29/2010 |
| Medicare PECOS PAC ID | 4385747831 |
|---|---|
| Medicare Enrollment ID | O20070321000403 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063548410 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | OS8622 (Florida) | Primary |
| Provider Name | Tasha B Wallace |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1396736997 PECOS PAC ID: 3173626835 Enrollment ID: I20070317000058 |
| Provider Name | Michelle Coloma Vallejo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356778427 PECOS PAC ID: 2466987078 Enrollment ID: I20241119004038 |
Galenus Group, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1530 Lee Blvd Ste 1400, Lehigh Acres, FL 33936 Phone: 239-368-7310 Fax: 239-368-7312 |
E& M Medical Services Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 415 Pauline Ave, Lehigh Acres, FL 33974 Phone: 239-738-8264 Fax: 239-236-1370 |
Best Care Community and Family Health Center, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2718 Lee Blvd Ste B, Lehigh Acres, FL 33971 Phone: 239-288-0840 Fax: 239-244-2195 |
Optimum Rehabilitation Specialists, Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2724 5th St W Ste A, Lehigh Acres, FL 33971 Phone: 239-470-3578 |
Vascular- Urology Lehighacres Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3227 Lee Blvd Ste F, Lehigh Acres, FL 33971 Phone: 239-424-2221 Fax: 239-424-4006 |
West Coast Injury & Rehablitation Center, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 5624 8th St W, Suite 111, Lehigh Acres, FL 33971 Phone: 239-674-7777 Fax: 239-674-7774 |