Organization
WAGNER INDIAN HEALTH SERVICE HEALTH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL HORNED EAGLE (CEO)
(605) 384-3621
Entity
Organization
Contact information
Practice address
111 WASHINGTON AVE, WAGNER, SD 57380
(605) 384-3621
(605) 384-3293
Mailing address
111 WASHINGTON AVE, WAGNER, SD 57380
(605) 384-3621
(605) 384-3293
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5540030
—
SD
05
—
5540280
—
SD
Enumeration date
07/17/2006
Last updated
11/20/2009
Update your record
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