Organization
T W WAGNER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TOMMY W WAGNER MD (OWNER/OPERATOR)
(870) 561-3300
Entity
Organization
Contact information
Practice address
730 GREENWOOD AVE, LEPANTO, AR 72354-3215
(870) 475-3825
Mailing address
PO BOX 910, MANILA, AR 72442-0910
(870) 561-3300
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Enumeration date
12/16/2024
Last updated
12/19/2024
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