Provider Demographics
NPI:1154534204
Name:WALNUT MEDICAL INC
Entity type:Organization
Organization Name:WALNUT MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:BRYAN
Authorized Official - Last Name:STARNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-381-8270
Mailing Address - Street 1:PO BOX 1267
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28603-1267
Mailing Address - Country:US
Mailing Address - Phone:252-291-0142
Mailing Address - Fax:866-526-3935
Practice Address - Street 1:56 3RD ST NW
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-6162
Practice Address - Country:US
Practice Address - Phone:910-521-5550
Practice Address - Fax:910-521-3335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00739332B00000X
NVMP00959332B00000X
UT8233940-1714332B00000X
IN69000936A332B00000X
VA0206009721332B00000X
SC13873332B00000X
OH23027332B00000X
IL203.001459332B00000X
PA6000008015332B00000X
KYHME00668332B00000X
NCDME.000445332B00000X
KS16-44418332B00000X
MI5306003748332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7704316Medicaid
NC4583740001Medicare NSC