Provider Demographics
NPI:1538958574
Name:WALLISER MEDICAL CENTER LLC
Entity type:Organization
Organization Name:WALLISER MEDICAL CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLISER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:423-760-9630
Mailing Address - Street 1:9380 BRADMORE LANE
Mailing Address - Street 2:STE 104
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-4447
Mailing Address - Country:US
Mailing Address - Phone:423-760-4630
Mailing Address - Fax:423-760-4631
Practice Address - Street 1:9380 BRADMORE LANE
Practice Address - Street 2:STE 104
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-4447
Practice Address - Country:US
Practice Address - Phone:423-760-4630
Practice Address - Fax:423-760-4631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-05
Last Update Date:2025-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty