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Search › Indiana › 363A00000X

Jacob Wall, PA-C

NPI 1932770005 · on the registry since 2021

Practice

Address
701 E County Line Rd Ste 302
Greenwood, IN 46143
Phone
(317) 859-8970
Fax
(317) 662-2302
Organisation at this address
Altus Direct, Llc
Indiana Sleep Center Llc
Southside Center For Sight
Indiana Dialysis Company Llc
Indiana Skin Cancer Center Pc
Inferred from a shared address, not stated in the registry.
Clinicians at this address
133

Registry record

Primary taxonomy
363A00000X
363A00000X
Licence states on file
IN
From the registry's licence fields, which are often incomplete.
Sex
Male
Record last updated
2026-05-27

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Indiana