Wallace Urgent Care Llc - Medicare Primary Care in Wallace, NC

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Wallace Urgent Care Llc is a medicare enrolled primary clinic (Clinic/center - Urgent Care) in Wallace, North Carolina. The current practice location for Wallace Urgent Care Llc is 112 Medical Village Dr, Unit F, Wallace, North Carolina. For appointments, you can reach them via phone at (910) 552-1580. The mailing address for Wallace Urgent Care Llc is 112 Medical Village Dr, Unit F, Wallace, North Carolina and phone number is (910) 552-1580.

Wallace Urgent Care Llc is licensed to practice in * (Not Available) (license number ). The clinic also participates in the medicare program and its NPI number is 1841259025. This medical practice accepts medicare insurance (which means this clinic accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance). However, please confirm if they accept your insurance at (910) 552-1580.

Contact Information

Wallace Urgent Care Llc
112 Medical Village Dr
Unit F
Wallace
NC 28466-9999
(910) 552-1580
(910) 665-1780

Map and Direction


Primary Care Clinic Profile

Full NameWallace Urgent Care Llc
SpecialityClinic/Center
Location112 Medical Village Dr, Wallace, North Carolina
Authorized Official Name and PositionKamran Goudarzi (OWNER)
Authorized Official Contact9105521580
Accepts Medicare InsuranceYes. This clinic participates in medicare program and accept medicare insurance.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Wallace Urgent Care Llc
112 Medical Village Dr
Unit F
Wallace
NC 28466-9999

Ph: (910) 552-1580		Wallace Urgent Care Llc
112 Medical Village Dr
Unit F
Wallace
NC 28466-9999

Ph: (910) 552-1580

NPI Details:

NPI Number1841259025
Provider Enumeration Date03/17/2006
Last Update Date02/04/2025

Medicare PECOS Information:

Medicare PECOS PAC ID6709967912
Medicare Enrollment IDO20080222000491

Medical Identifiers

Medical identifiers for Wallace Urgent Care Llc such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1841259025NPI-NPPES
01736OtherNCNCBCBS PROVIDER NUMBER
7901736MedicaidNC

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
261Q00000XClinic/center (* (Not Available))Secondary
261QU0200XClinic/center - Urgent Care (* (Not Available))Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Wallace Urgent Care Llc acts as a billing entity for following providers:
Provider NameJeffrey W Autry
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1063474559
PECOS PAC ID: 9537253208
Enrollment ID: I20070926000274
Provider NameMaryanna Johnson
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1720541220
PECOS PAC ID: 5395078869
Enrollment ID: I20190615000203
Provider NameJeffrey Lance
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1902281132
PECOS PAC ID: 5597065516
Enrollment ID: I20200510000096
Provider NameJennifer Nicole Brennan
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1730804907
PECOS PAC ID: 5698145399
Enrollment ID: I20221221000215

Reviews and Comments


Clinic/Center in Wallace, NC


Primary Care Clinic
Medicare: Not Enrolled in Medicare
Practice Location: 112 Medical Village Dr, Ste G, Wallace, NC 28466
Phone: 910-285-0333    

Primary Care Clinic
Medicare: Not Enrolled in Medicare
Practice Location: 112 Medical Village Dr Ste F, Wallace, NC 28466
Phone: 910-285-0940    Fax: 910-285-1825

Primary Care Clinic
Medicare: Not Enrolled in Medicare
Practice Location: 4266 S Nc Highway 11, Wallace, NC 28466
Phone: 910-267-1942    
Blair Family Medicine
Primary Care Clinic
Medicare: Not Enrolled in Medicare
Practice Location: 404 E Main St, Wallace, NC 28466
Phone: 910-285-3380    
Daniel M Ricci M.d. P.a.
Primary Care Clinic
Medicare: Medicare Enrolled
Practice Location: 207 E Murphy St, Wallace, NC 28466
Phone: 910-285-4100    Fax: 910-285-4766
Po Powell Management Group, Llc
Primary Care Clinic
Medicare: Not Enrolled in Medicare
Practice Location: 112 Medical Village Dr Ste F, Wallace, NC 28466
Phone: 910-665-1780    Fax: 910-665-1780

Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.