Provider Demographics
NPI:1134395080
Name:MYLES MILTON WALKER, SR.
Entity type:Organization
Organization Name:MYLES MILTON WALKER, SR.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MYLES
Authorized Official - Middle Name:MILTON
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:603-472-3586
Mailing Address - Street 1:164 WALLACE RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-5140
Mailing Address - Country:US
Mailing Address - Phone:603-472-3586
Mailing Address - Fax:603-472-6957
Practice Address - Street 1:164 WALLACE RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-5140
Practice Address - Country:US
Practice Address - Phone:603-472-3586
Practice Address - Fax:603-472-6957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHHR10332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH99908503Medicaid