Provider Demographics
NPI:1730280876
Name:WALTCO MEDICAL EQUIPMENT & SUPPLIES,INC.
Entity Type:Organization
Organization Name:WALTCO MEDICAL EQUIPMENT & SUPPLIES,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-290-9033
Mailing Address - Street 1:1200 E DAVIS ST
Mailing Address - Street 2:SUITE 113
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-8729
Mailing Address - Country:US
Mailing Address - Phone:972-290-9033
Mailing Address - Fax:972-288-9947
Practice Address - Street 1:1200 E DAVIS ST
Practice Address - Street 2:SUITE 113
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-8729
Practice Address - Country:US
Practice Address - Phone:972-290-9033
Practice Address - Fax:972-288-9947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0067012332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4692410001Medicare NSC