MEDICARE: CALEB WALLER QBHS-HS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1174455174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CALEB WALLER QBHS-HS

Provider Business Mailing Address
First Line	:	4764 FISHBURG RD STE E
Second Line	:
City	:	HUBER HEIGHTS
State	:	OH
Zip	:	45424-5456
Country	:	US
Telephone Number	:	317-531-7990
Fax Number	:	937-660-4071

Provider Business Practice Location Address
First Line	:	4764 FISHBURG RD STE E
Second Line	:
City	:	HUBER HEIGHTS
State	:	OH
Zip	:	45424-5456
Country	:	US
Telephone Number	:	317-531-7990
Fax Number	:	937-660-4071

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2026
Last Update Date	:	06/02/2026

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