Healthcare Provider Details

I. General information

NPI: 1134395080
Provider Name (Legal Business Name): MYLES MILTON WALKER, SR.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2008
Last Update Date: 07/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 WALLACE RD
BEDFORD NH
03110-5140
US

IV. Provider business mailing address

164 WALLACE RD
BEDFORD NH
03110-5140
US

V. Phone/Fax

Practice location:
  • Phone: 603-472-3586
  • Fax: 603-472-6957
Mailing address:
  • Phone: 603-472-3586
  • Fax: 603-472-6957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License NumberHR10
License Number StateNH

VIII. Authorized Official

Name: MYLES MILTON WALKER SR.
Title or Position: DIRECTOR
Credential:
Phone: 603-472-3586