Provider Demographics
NPI:1164654539
Name:WALSON, INC,
Entity Type:Organization
Organization Name:WALSON, INC,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:409-835-3091
Mailing Address - Street 1:50 N 11TH ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-2225
Mailing Address - Country:US
Mailing Address - Phone:409-835-3091
Mailing Address - Fax:409-835-3850
Practice Address - Street 1:1615 W CHURCH ST
Practice Address - Street 2:SUITE 700
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351-9004
Practice Address - Country:US
Practice Address - Phone:800-260-3091
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-18
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX015605101Medicaid
TX0283660003Medicare NSC