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Contact Information

RICHARD J WALLACE, PA-C
13649 CHURCH STREET
WILLISTON, SC29853
 Phone: 803-266-0060
 Fax: 803-266-0042
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Physician Assistant

363A00000X 97 Physician Assistant
Indicates primary specialty

NPI Profile & details for RICHARD J WALLACE · (Male)

NPI Number 1841583788
Status Active
Credentials PA-C (Physician Assistant-Certified)
Entity Individual
Enumeration date 05/25/2011
Last updated 01/11/2024 - About 2 years ago
Sole proprietor 1 No
Identifiers
  • SC Medicaid 3559PA
  • SC Other 2920 MEDICAL LICENSE
  • SC Other SCE705 MEDICARE
Hospital affiliation(s)
  • AIKEN REGIONAL MEDICAL CENTER - (Acute Care)
    302 UNIVERSITY PARKWAY
    AIKEN, SC 29801
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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