T W WAGNER INC NPI 1316041957

NPI Information

T W WAGNER INC is a rural health clinic center in Lepanto, AR. T W WAGNER INC NPI is 1316041957. The provider is registered as an organization entity type.
The provider Is Doing Business As Wagner Medical Clinic.

The provider's business location address is:

331 BROAD STREET
SUITE B
LEPANTO, AR
ZIP 72354
Phone: (870) 475-3825
Fax: (870) 475-3823

The provider's authorized official is Tommy W Wagner .
The authorized official title is Owner and has the following contact phone number (870) 561-3300.

The CLIA number assigned to this NPI record is 04D1055975 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/12/2006 and was last updated on 8/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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