Organization
WAGNER COMMUNITY MEMORIAL HOSPITAL
Active
Other names
Wagner Community Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRYAN SLABA (CEO)
(605) 384-3611
Entity
Organization
Contact information
Practice address
513 3RD ST SW, WAGNER, SD 57380-9675
(605) 384-3611
(605) 384-3232
Mailing address
513 3RD ST SW, WAGNER, SD 57380-9675
(605) 384-3611
(605) 384-3232
Taxonomy
Speciality
Code
Description
License number
State
282NC0060X
Critical Access Hospital
Primary
10571
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0100490
—
SD
01
—
4997772
WELLMARK CRNA
SD
05
—
5500490
—
SD
05
—
5800140
—
SD
01
—
81315
BLUE CROSS
SD
05
—
9580610
—
SD
Enumeration date
08/19/2005
Last updated
03/07/2017
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