Individual
MR. RICHARD JEREMY WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
13649 CHURCH STREET, WILLISTON, SC 29853
(803) 266-0060
(803) 266-0042
Mailing address
86 WREN ST, BARNWELL, SC 29812-1529
(803) 259-5762
(803) 259-3250
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2920
MEDICAL LICENSE
SC
05
—
3559PA
—
SC
01
—
SCE705
MEDICARE
SC
Enumeration date
05/25/2011
Last updated
01/11/2024
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us