Marty Dale Wallace is a Johnson City, Tennessee based nurse anesthetist with 17 years of experience as Anesthesia Administration. He completed he graduation in 2008. He accepts the Medicare-approved amount. Patients will not be billed for any more than the Medicare deductible and coinsurance. Active license number of Marty Dale Wallace is APN13700 for Anesthesia Administration in Tennessee. his current practice location is 1114 Sunset Dr, Suite 4, Johnson City. Patients can reach him at 423-283-0776 or can fax him at 423-283-0549. Marty Dale Wallace is CRNA with specialization in Anesthesia Administration and he NPI number (Unique professional ID assigned by NPPES) is 1164674743. Marty Dale Wallace is a certified registered nurse with advanced specialty education in anesthesia who, in collaboration with appropriate health care professionals, provides preoperative, intraoperative, and postoperative care to patients and assists in management and resuscitation of critical patients in intensive care, coronary care, and emergency situations. Nurse anesthetists are certified following successful completion of credentials and state licensure review and a national examination directed by the Council on Certification of Nurse Anesthetists.
Complete Profile:
Marty Dale Wallace speciality, credentials, practice address, contact phone number and fax are as below.
Patients can directly walk in or can call on the below given phone number for appointment.
Specialization:
Anesthesia Administration
Credentials:
CRNA
Experience:
17+ years
Medical School Attended:
Other
Graduation Year:
2008
Gender:
Male
Accepts Medicare Assignment:
Yes
Practice Address:
1114 Sunset Dr, Suite 4, Johnson City, Tennessee, 37604-2969
Phone:
423-283-0776
Fax:
423-283-0549
Professional Identification Codes:
NPI number stands for National Provider Identifier which is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS).
NPI details are as mentioned below.
PAC ID:
5799845822
Enrollment ID:
I20110610000365
NPI Number:
1164674743
NPI Enumeration Date:
15 Oct, 2008
NPI Last Update On:
20 Nov, 2009
Medical Licenses:
Nurses can have one or more medical licenses for different specialities in the same state or different states. Related medical licenses for Marty Dale Wallace are as mentioned below.
License Number
Specialization
State
Status
APN13700
Anesthesia Administration
Tennessee
Primary
Hospital Affiliation:
Surgeons are affiliated to many hospitals whom they worked with in the past or are presently working with. One surgeon can be affiliated to four to five hospitals at a time.
Hospital Name (CCN)
State
Hospital Type
Huntsville Hospital (010039)
Huntsville, AL
Acute Care Hospital
Group Practice:
Group practices are run by a group of physicians who share their premises and other resources. Following list states all the group name
with which Marty Dale Wallace has association with along with the number of members in that group.
Organization Name (Group PAC ID)
Members
Huntsville Hospital Anesthesia (7315990751)
142
Other Medical Identifiers:
Other legacy medical identifiers associated with Marty Dale Wallace such as Medicaid, Medicare PIN, NSC, UPIN etc. are mentioned as below.
Identifier
Type
State
Issuer
1510077
Medicaid
Tennessee
Business Mailing Address:
Business mailing address can be used for mailing purpose only, for visiting purpose patients need to refer above mentioned address.
Address:
Po Box 3727, Johnson City, Tennessee
Zip:
37602-3727
Phone Number:
423-283-0776
Fax Number:
423-283-0549
Patients can reach Marty Dale Wallace at 1114 Sunset Dr, Suite 4, Johnson City, Tennessee or can call to book an appointment on 423-283-0776.
Comments/ Reviews:
Data of this site is collected from Medicare & Medicaid Services (CMS) and NPPES. Last updated on 10 March, 2025.