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NPI Code Detail

MEDICARE: JAMES A. WALLACE

MEDICARE: JAMES A. WALLACE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1689513806
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES A. WALLACE
Provider Business Mailing Address
First Line : 11767 KATY FWY STE 1130
Second Line :
City : HOUSTON
State : TX
Zip : 77079-1731
Country : US
Telephone Number : 817-919-3092
Fax Number : 832-550-2814
Provider Business Practice Location Address
First Line : 11767 KATY FWY STE 1130
Second Line :
City : HOUSTON
State : TX
Zip : 77079-1731
Country : US
Telephone Number : 817-919-3092
Fax Number : 832-550-2814
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/25/2026
Last Update Date : 03/25/2026

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