Provider Demographics
NPI:1407928625
Name:WALTER BROS INC
Entity Type:Organization
Organization Name:WALTER BROS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:WALTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-342-3003
Mailing Address - Street 1:95 S BERTELSEN RD
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-5371
Mailing Address - Country:US
Mailing Address - Phone:541-342-3003
Mailing Address - Fax:541-342-6229
Practice Address - Street 1:95 S BERTELSEN RD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-5371
Practice Address - Country:US
Practice Address - Phone:541-342-3003
Practice Address - Fax:541-342-6229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2044-063416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR229140Medicaid
ORR107454Medicare ID - Type UnspecifiedPROVIDER NUMBER
OROR03459Medicare ID - Type UnspecifiedTRADING PARTNER ID