# ST. MARY'S HEALTH WAGON

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** The Health Wagon
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114356037
- **Authorized official:** MS. TERESA L. GARDNER D.N.P. (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (276) 328-8850

## Contact information

- **Practice address:** 5626 PATRIOT DRIVE, WISE, VA 24293-7070
- **Practice address phone:** (276) 328-8850
- **Practice address fax:** (276) 328-8853
- **Mailing address:** 5626 PATRIOT DRIVE, WISE, VA 24293-7070
- **Mailing address phone:** (276) 328-8850
- **Mailing address fax:** (276) 328-8853

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/02/2013
- **Last updated:** 11/02/2013