Organization
T W WAGNER INC
Active
Other names
WAGNER MEDICAL CLINIC
Organization subpart
No
Provider details
NPI number
Authorized official
TOMMY W WAGNER JR. MD (OWNER)
(870) 561-3300
Entity
Organization
Contact information
Practice address
331 BROAD STREET, SUITE B, LEPANTO, AR 72354
(870) 475-3825
(870) 475-3823
Mailing address
331 BROAD STREET, SUITE B, LEPANTO, AR 72354
(870) 475-3825
(870) 475-3823
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Enumeration date
09/12/2006
Last updated
08/22/2020
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