Organization
WAGONER MEDICAL CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE WAGONER (ADMINISTRATOR)
(765) 566-3303
Entity
Organization
Contact information
Practice address
821 N DIXON RD, KOKOMO, IN 46901-1754
(765) 452-0878
(765) 566-2250
Mailing address
PO BOX 38, BURLINGTON, IN 46915-0038
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200062260C
—
IN
Enumeration date
04/16/2007
Last updated
05/15/2009
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