Provider Demographics
NPI:1598832008
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
Mailing Address - Country:US
Mailing Address - Phone:814-533-0901
Mailing Address - Fax:814-533-0196
Practice Address - Street 1:202 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:PA
Practice Address - Zip Code:15537-7057
Practice Address - Country:US
Practice Address - Phone:814-624-0669
Practice Address - Fax:814-624-0679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA3000007084332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009718520002Medicaid
PA0197870002Medicare NSC