WAGONER HOLDINGS PA NPI 1679236400

NPI Information

NPI: 1679236400
Provider Name: WAGONER HOLDINGS PA
Classification: Clinic/Center - 261QH0100X
Entity Type: Organization

Specialization: Health Service

Address:
851 WAKE FOREST BUSINESS PARK STE E
WAKE FOREST, NC
ZIP 27587
Phone: (260) 573-1249
Get Directions

WAGONER HOLDINGS PA is a health service clinic center in Wake Forest, NC. WAGONER HOLDINGS PA NPI is 1679236400. The provider is registered as an organization entity type.

The provider's business location address is:

851 WAKE FOREST BUSINESS PARK STE E
WAKE FOREST, NC
ZIP 27587-366
Phone: (260) 573-1249

The provider's authorized official is Evan Jonathon Wagoner .
The authorized official title is Owner and has the following contact phone number (260) 573-1249.

The enumeration date for this NPI number is 10/19/2021 and was last updated on 10/19/2021.

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:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QH0100X	Clinic/Center	Health Service			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	5176	OTHER	NORTH CAROLINA	NC STATE CHIROPRACTIC LICENSE NUMBER

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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