Individual ProviderWallace Jennings HorneEmergency MedicineAllopathic & Osteopathic PhysiciansPractice Address800 Tilghman Dr, Dunn, NC 28334-5510(910) 694-1000PECOS EnrollmentBased on the most recent information from CMS, provider Wallace Jennings Horne does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 10:10 AM.Profile DetailsProvider ID1659352052Provider TypeIndividualFull NameHorne, Wallace JenningsCredentialMDGenderMaleSole ProprietorYesEnumeration Date11/11/2005Last Updated11/8/2011Contact InformationPractice LocationPractice Address800 Tilghman Dr, Dunn, NC 28334-5510Phone(910) 694-1000Fax(910) 891-6030Mailing LocationMailing AddressPO Box 1706, 800 Tilghman Drive, Dunn, NC 28335-1706Phone(910) 694-1000Fax(910) 891-6030Provider TaxonomiesCodeDescriptionLicenseCode207P00000XPrimaryDescriptionEmergency MedicineAllopathic & Osteopathic PhysiciansLicense0101034381VirginiaCode207Q00000XDescriptionFamily MedicineAllopathic & Osteopathic PhysiciansLicense0101034381VirginiaProvider IdentifiersIDDescriptionIssuerID5869862DescriptionMedicaidIssuerUnlistedVirginia