Provider Demographics
NPI:1538233614
Name:WALKER EAZE LLC
Entity type:Organization
Organization Name:WALKER EAZE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:HOMER
Authorized Official - Middle Name:VALLES
Authorized Official - Last Name:URIBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-233-2202
Mailing Address - Street 1:19219 SOUTH HIGHWAY 28
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:NM
Mailing Address - Zip Code:88044-9621
Mailing Address - Country:US
Mailing Address - Phone:505-233-2202
Mailing Address - Fax:505-526-9787
Practice Address - Street 1:19219 SOUTH HIGHWAY 28
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:NM
Practice Address - Zip Code:88044-9621
Practice Address - Country:US
Practice Address - Phone:505-233-2202
Practice Address - Fax:505-526-9787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies