=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104066380
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WALKER SURGICAL SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/27/2009
-----------------------------------------------------
Last Update Date | 11/13/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 186 BIG OAK DR
-----------------------------------------------------
City | ADKINS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78101-2753
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-264-1728
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1198
-----------------------------------------------------
City | LA VERNIA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78121-1198
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-264-1728
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED SURGICAL ASSISTANT
-----------------------------------------------------
Name | DELINA KATHERINE WALKER
-----------------------------------------------------
Credential | LSA
-----------------------------------------------------
Telephone | 210-264-1728
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AS0400X
-----------------------------------------------------
Taxonomy Name | Surgical Physician Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------