Provider Demographics
NPI:1992953046
Name:WATER WALKERS, LLC
Entity type:Organization
Organization Name:WATER WALKERS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:ELDON
Authorized Official - Last Name:MOFFIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-207-6691
Mailing Address - Street 1:3200 W CENTRE AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-4889
Mailing Address - Country:US
Mailing Address - Phone:269-365-3677
Mailing Address - Fax:866-431-9323
Practice Address - Street 1:3200 W CENTRE AVE
Practice Address - Street 2:STE 201
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-4889
Practice Address - Country:US
Practice Address - Phone:269-365-3677
Practice Address - Fax:866-431-9323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6188770001Medicare NSC