| Organization Name: | WALLACE HOME MEDICAL SUPPLIES |
| NPI Number: | 1215096466 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MATTHEW TRAGO WALLACE (OWNER) |
| Mailing Address: | 1414 Park St Paso Robles |
| State: | CA US |
| Postal Code: | 934462160 |
| Phone Number: | 8052383935 |
| Fax Number: | 8052383974 |
| NPI Enumeration Date: | 12/06/2006 |
| NPI Last Update Date: | 04/20/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332BX2000X |
| License Number: | 18268 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CA |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | Oxygen Equipment & Supplies |
| Taxonomy Definition: | |