Basic Information
| Provider Information | |||||||||
| NPI: | 1801241666 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WALKER CONSTRUCTION | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 295 | ||||||||
| Address2: | |||||||||
| City: | WEST UNION | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456930295 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9375447200 | ||||||||
| FaxNumber: | 9375447211 | ||||||||
| Practice Location | |||||||||
| Address1: | 1216 LOGANS LN | ||||||||
| Address2: | |||||||||
| City: | WEST UNION | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456939631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9375447200 | ||||||||
| FaxNumber: | 9375447211 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2016 | ||||||||
| LastUpdateDate: | 04/29/2016 | ||||||||
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| AuthorizedOfficialLastName: | WALKER | ||||||||
| AuthorizedOfficialFirstName: | RODNEY | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9375447200 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171WH0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Contractor | Home Modifications |
ID Information
| ID | Type | State | Issuer | Description | 2644606 | 05 | OH | MEDICAID | 0240724 | 05 | OH | MEDICAID |