Wallace Family Practice PA
NPI 1063548410 · Clinic/Center · Lehigh Acres, FL
Enrolled with Medicare as Part B Supplier - Clinic/Group Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Wallace Family Practice PA is a Clinic/Center organization in Lehigh Acres, FL (NPI 1063548410).
Provider details
- NPI number
- 1063548410
- Entity type
- Organization
- Primary specialty
- Clinic/CenterAmbulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Tasha Wallace, President(239) 369-2903
- License
- OS8622 (FL)
Specialties & taxonomies
Ambulatory Health Care Facilities
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
19 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Registry dates
- Enumerated
- 2007-02-27
- Last updated
- 2010-12-29
Frequently asked questions
- What is Wallace Family Practice PA's NPI number?
- Wallace Family Practice PA's National Provider Identifier (NPI) is 1063548410, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Wallace Family Practice PA?
- Wallace Family Practice PA is classified in the NPPES registry as Clinic/Center (Ambulatory Health Care Facilities).
- Where is Wallace Family Practice PA located?
- Wallace Family Practice PA's practice location on file with NPPES is 3400 Lee Blvd, Lehigh Acres, FL 33971-1309.
- What is Wallace Family Practice PA's phone number?
- The practice phone number listed in the NPPES registry for Wallace Family Practice PA is (239) 369-2903.
- Does Wallace Family Practice PA accept Medicare?
- Wallace Family Practice PA is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Who is the authorized official for Wallace Family Practice PA?
- The authorized official listed on Wallace Family Practice PA's NPPES record is Tasha Wallace, President. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Wallace Family Practice PA's NPI active?
- Yes — Wallace Family Practice PA's NPI (1063548410) is active in the NPPES registry as of the last update on 2010-12-29.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.