Provider Demographics
NPI:1164524435
Name:WALNUT MANAGEMENT CORP
Entity Type:Organization
Organization Name:WALNUT MANAGEMENT CORP
Other - Org Name:WALNUT MEDICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-533-0901
Mailing Address - Street 1:226 MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15901-1509
Mailing Address - Country:US
Mailing Address - Phone:814-533-0901
Mailing Address - Fax:814-533-0196
Practice Address - Street 1:226 MAIN ST.
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15901-1509
Practice Address - Country:US
Practice Address - Phone:814-533-0901
Practice Address - Fax:814-533-0196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA80000000542332B00000X
PA1000002361332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009718520002Medicaid
PA0009718520002Medicaid