# WAGONER MEDICAL CENTER, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1457421497
- **Authorized official:** MICHELLE WAGONER (ADMINISTRATOR)
- **Authorized official phone:** (765) 566-3351

## Contact information

- **Practice address:** 605 EAST 7TH STREET, BURLINGTON, IN 46915-0038
- **Practice address phone:** (765) 566-3351
- **Practice address fax:** (765) 566-2250
- **Mailing address:** PO BOX 38, BURLINGTON, IN 46915-0038
- **Mailing address phone:** (765) 566-3351
- **Mailing address fax:** (765) 566-2250

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 207RC0200X | Critical Care Medicine (Internal Medicine) Physician | — | NULL | — |
| 207RC0200X | Critical Care Medicine (Internal Medicine) Physician | — | — | — |
| 207RP1001X | Pulmonary Disease Physician | — | NULL | — |
| 207RP1001X | Pulmonary Disease Physician | — | — | — |

## Other

- **Enumeration date:** 11/08/2006
- **Last updated:** 05/15/2009