LARRY R WALTON NPI 1063440311

NPI Information

NPI: 1063440311
Provider Name: LARRY R WALTON
Classification: Specialist - 174400000X
Entity Type: Individual
Address:
1220 WEST MILHAM AVE
PORTAGE, MI
ZIP 49024
Phone: (269) 382-9900
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Larry R Walton is a specialist in Portage, MI. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. Larry R Walton NPI is 1063440311. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

1220 WEST MILHAM AVE
PORTAGE, MI
ZIP 49024-206
Phone: (269) 382-9900
Fax: (269) 382-0700

The enumeration date for this NPI number is 6/28/2006 and was last updated on 8/11/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	335E00000X	Prosthetic/Orthotic Supplier		039773	MICHIGAN	No
2	174400000X	Specialist		039773	MICHIGAN	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	B47561	MEDICARE UPIN	MICHIGAN
2	0N56560	MEDICARE PIN	MICHIGAN
3	039279	OTHER	MICHIGAN	BCBS PROVIDER ID
4	4079644	MEDICAID	MICHIGAN
5	4495410001	MEDICARE NSC	MICHIGAN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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