Provider Demographics
NPI:1861720849
Name:WALLER FAMILY HEALTH SYSTEMS LLC
Entity type:Organization
Organization Name:WALLER FAMILY HEALTH SYSTEMS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:WALLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-722-0054
Mailing Address - Street 1:4550 SKY HARBOR DR
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-0629
Mailing Address - Country:US
Mailing Address - Phone:903-629-5087
Mailing Address - Fax:
Practice Address - Street 1:4210 RIDGE RD
Practice Address - Street 2:STE 102
Practice Address - City:HEATH
Practice Address - State:TX
Practice Address - Zip Code:75032-6602
Practice Address - Country:US
Practice Address - Phone:972-722-0054
Practice Address - Fax:972-722-0096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-02
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8656261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center