# WALLACE HOME MEDICAL SUPPLIES

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** WALLACE HOME MEDICAL SUPPLIES
- **Other names:** Wallace Home Medical Supplies
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1902200918
- **Legal business name:** WALLACE HOME MEDICAL SUPPLIES
- **Authorized official:** MATTHEW TRAGO WALLACE (PRESIDENT)
- **Authorized official phone:** (805) 238-3935

## Contact information

- **Practice address:** 12310 LOS OSOS VALLEY RD, SAN LUIS OBISPO, CA 93405-7220
- **Practice address phone:** (805) 439-4007
- **Mailing address:** 549 10TH ST, PASO ROBLES, CA 93446-2510
- **Mailing address phone:** (805) 238-3935

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | Yes |

## Other

- **Enumeration date:** 10/20/2014
- **Last updated:** 08/06/2015