Provider Demographics
NPI:1699828509
Name:WALNUT MANAGEMENT CORPORATION
Entity Type:Organization
Organization Name:WALNUT MANAGEMENT CORPORATION
Other - Org Name:WALNUT MEDICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, WMS
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:KAISER
Authorized Official - Suffix:
Authorized Official - Credentials:RRT
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:815-533-0196
Practice Address - Street 1:307 S LOGAN BLVD
Practice Address - Street 2:
Practice Address - City:BURNHAM
Practice Address - State:PA
Practice Address - Zip Code:17009-1869
Practice Address - Country:US
Practice Address - Phone:717-248-9938
Practice Address - Fax:717-248-9939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA3000007974332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009718520005Medicaid
PA0197870004Medicare NSC