# WAGNER COMMUNITY MEMORIAL HOSPITAL

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** WAGNER COMMUNITY MEMORIAL HOSPITAL
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1629135645
- **Legal business name:** WAGNER COMMUNITY MEMORIAL HOSPITAL
- **Authorized official:** MR. BRYAN SLABA (CEO)
- **Authorized official phone:** (605) 384-3611

## Contact information

- **Practice address:** 513 3RD ST SW, WAGNER, SD 57380-0280
- **Practice address phone:** (605) 384-3611
- **Practice address fax:** (605) 384-3232
- **Mailing address:** 513 3RD ST SW, PO BOX 280, WAGNER, SD 57380-0280
- **Mailing address phone:** (605) 384-3611
- **Mailing address fax:** (605) 384-3232

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 275N00000X | Medicare Defined Swing Bed Hospital Unit | 10571 | SD | Yes |
| 282E00000X | Long Term Care Hospital | 10571 | SD | — |

## Other

- **Enumeration date:** 01/02/2007
- **Last updated:** 03/07/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1007417 | — | SD |
| 01 | — | 8Z1315 | BC SLTC | SD |