| Walls Medicine Clinic Llc | |
|
1801 Fairfield Ave. Ste 200 Shreveport LA 71101 | |
| (318) 675-1800 | |
| (318) 675-1818 |
| Full Name | Walls Medicine Clinic Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1801 Fairfield Ave. Ste 200, Shreveport, Louisiana |
| Authorized Official Name and Position | Wendell E. Wall (OWNER) |
| Authorized Official Contact | 3186751800 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Walls Medicine Clinic Llc 1801 Fairfield Ave. Ste 200 Shreveport LA 71101 Ph: (318) 675-1800 | Walls Medicine Clinic Llc 1801 Fairfield Ave. Ste 200 Shreveport LA 71101 Ph: (318) 675-1800 |
| NPI Number | 1497937601 |
|---|---|
| Provider Enumeration Date | 11/29/2007 |
| Last Update Date | 11/09/2018 |
| Medicare PECOS PAC ID | 5294816138 |
|---|---|
| Medicare Enrollment ID | O20080116000580 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497937601 | NPI | - | NPPES |
| 1663841 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 11458R (Louisiana) | Primary |
| Provider Name | Wendell Wall |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1639174105 PECOS PAC ID: 4688755523 Enrollment ID: I20080116000559 |
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