Provider Demographics
NPI:1558435198
Name:SAMUEL C WALKER NMD PC
Entity Type:Organization
Organization Name:SAMUEL C WALKER NMD PC
Other - Org Name:CENTRO DE SALUD FAMILIAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:RN, NMD
Authorized Official - Phone:602-241-9105
Mailing Address - Street 1:1000 E INDIAN SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-4810
Mailing Address - Country:US
Mailing Address - Phone:602-241-9105
Mailing Address - Fax:602-241-9104
Practice Address - Street 1:1000 E INDIAN SCHOOL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-4810
Practice Address - Country:US
Practice Address - Phone:602-241-9105
Practice Address - Fax:602-241-9104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ97-499175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty