Provider Demographics
NPI:1831580117
Name:WALNUT SPRINGS ELDER CARE LLC
Entity type:Organization
Organization Name:WALNUT SPRINGS ELDER CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-379-8811
Mailing Address - Street 1:214 N CAMP ST
Mailing Address - Street 2:
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155-5631
Mailing Address - Country:US
Mailing Address - Phone:830-379-8811
Mailing Address - Fax:830-379-2325
Practice Address - Street 1:214 N CAMP ST
Practice Address - Street 2:
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155-5631
Practice Address - Country:US
Practice Address - Phone:830-379-8811
Practice Address - Fax:830-379-2325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-09
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty