Provider Demographics
NPI:1154512424
Name:JOHN D WALLACE ENTERPRISES
Entity Type:Organization
Organization Name:JOHN D WALLACE ENTERPRISES
Other - Org Name:FAMILY HEALTH CARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-514-0330
Mailing Address - Street 1:513 GEORGE ST
Mailing Address - Street 2:A
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28560-4811
Mailing Address - Country:US
Mailing Address - Phone:252-514-0330
Mailing Address - Fax:
Practice Address - Street 1:513 GEORGE ST
Practice Address - Street 2:A
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28560-4811
Practice Address - Country:US
Practice Address - Phone:252-514-0330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization