Provider Demographics
NPI:1295911477
Name:WALTER T. TILLMAN INC
Entity type:Organization
Organization Name:WALTER T. TILLMAN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:T
Authorized Official - Last Name:TILLMAN
Authorized Official - Suffix:III
Authorized Official - Credentials:BCO
Authorized Official - Phone:412-283-4961
Mailing Address - Street 1:2414 LYTLE RD
Mailing Address - Street 2:SUITE 202 HIRAS PROFESSIONAL BUILDING
Mailing Address - City:BETHEL PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15102-2736
Mailing Address - Country:US
Mailing Address - Phone:412-283-4961
Mailing Address - Fax:412-283-4962
Practice Address - Street 1:2414 LYTLE RD STE 202
Practice Address - Street 2:
Practice Address - City:BETHEL PARK
Practice Address - State:PA
Practice Address - Zip Code:15102-2755
Practice Address - Country:US
Practice Address - Phone:412-283-4961
Practice Address - Fax:412-283-4962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-17
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
1972513356OtherINDIVIDUAL NPI NUMBER
PA0013947050002Medicaid