Sara Sheehan Wallace, MD | |
3240 Sunset Blvd, West Columbia, SC 29169-3428 | |
(803) 359-8855 | |
(803) 794-6480 |
Full Name | Sara Sheehan Wallace |
---|---|
Gender | Female |
Speciality | Pediatrics |
Location | 3240 Sunset Blvd, West Columbia, South Carolina |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1003255605 | NPI | - | NPPES |
358099 | Medicaid | SC | |
35809 | Other | SC | SC MEDICAL LICENSE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208000000X | Pediatrics | LL35809 (South Carolina) | Secondary |
208000000X | Pediatrics | 35809 (South Carolina) | Primary |
Entity Name | Prisma Health University Medical Group |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1295763217 PECOS PAC ID: 8325950983 Enrollment ID: O20031103000238 |
Entity Name | Anmed Health |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1639102270 PECOS PAC ID: 1951215243 Enrollment ID: O20040130000302 |
Entity Name | Baptist Easley Hospital |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1144452889 PECOS PAC ID: 0840337606 Enrollment ID: O20091027000684 |
Entity Name | Prisma Health Medical Group-midlands |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1275988321 PECOS PAC ID: 5991099707 Enrollment ID: O20160802001226 |
Entity Name | Lexington Health Inc |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1710634753 PECOS PAC ID: 2567872070 Enrollment ID: O20201208000922 |
Mailing Address | Practice Location Address |
---|---|
Sara Sheehan Wallace, MD Po Box 6069, West Columbia, SC 29171-6069 Ph: (803) 359-8855 | Sara Sheehan Wallace, MD 3240 Sunset Blvd, West Columbia, SC 29169-3428 Ph: (803) 359-8855 |
Amanda Lynn Goodno, MD Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 500 N 12th St, West Columbia, SC 29169 Phone: 803-217-0415 Fax: 803-939-1650 | |
Larry C Smith Ii, MD Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 172 Mcswain Drive, Suite A, West Columbia, SC 29169 Phone: 800-809-1265 Fax: 803-771-7782 | |
Dr. Sharada M Pai, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 209 Timber Ridge Dr, West Columbia, SC 29169 Phone: 803-794-5307 | |
Katherine Joy Atkinson, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 500 N 12th St, West Columbia, SC 29169 Phone: 803-217-0415 Fax: 803-939-1650 | |
Jonathan William Ceral Brock, MD, PHD Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 2318a Sunset Blvd, West Columbia, SC 29169 Phone: 803-796-9200 Fax: 803-462-0312 | |
Ronnie W Neuberg, MD Pediatrics Medicare: Accepting Medicare Assignments Practice Location: 112 Saluda Ridge Ct Ste 200, West Columbia, SC 29169 Phone: 803-794-0200 Fax: 803-794-0404 |