43D0953483 CLIA NUMBER - WAGNER COMMUNITY CLINIC - AVERA

Laboratory Demographics

CLIA Number: 43D0953483

Facility Name: WAGNER COMMUNITY CLINIC - AVERA

Facility Address:
513 SW 3RD STREET
WAGNER, SD
ZIP 57380
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Facility Phone Number: 605 384-3611

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1629135645

Taxonomy: 275N00000X - Medicare Defined Swing Bed Unit
A unit of a hospital that has a Medicare provider agreement and has been granted approval from HCFA to provide post-hospital extended care services and be reimbursed as a swing-bed unit.

CLIA Record

Field Name	Field Value
CLIA Number	43D0953483
LAB Type	Physician Office
Facility Name	WAGNER COMMUNITY CLINIC - AVERA
Street	513 SW 3RD STREET
City	WAGNER
State	SD
ZIP	57380
Phone	605 384-3611
CertificateType	4
CertificateEffectiveDate	11/3/2022
CertificateExpirationDate	11/2/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024