Healthcare Provider Details

I. General information

NPI: 1538376108
Provider Name (Legal Business Name): WALTER MAURIECE CHENEY CPO LPO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 02/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 MONTANA AVE STE C
EL PASO TX
79903-4507
US

IV. Provider business mailing address

8630 HICKORY DR
ANTHONY TX
79821-9275
US

V. Phone/Fax

Practice location:
  • Phone: 915-566-3440
  • Fax: 915-566-1485
Mailing address:
  • Phone: 915-474-7216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number16
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number101161
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: