Organization
T W WAGNER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TOMMY W WAGNER JR. M.D. (OWNER)
(870) 561-3300
Entity
Organization
Contact information
Practice address
3644 W STATE HIGHWAY 18, MANILA, AR 72442-8049
(870) 561-3300
(870) 561-3307
Mailing address
PO BOX 910, MANILA, AR 72442-0910
(870) 561-3300
(870) 561-3307
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
157742729
—
AR
Enumeration date
12/06/2005
Last updated
07/22/2016
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