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
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
207Q00000X
Family Medicine Physician
Primary
E3873
AR
363LF0000X
Family Nurse Practitioner
A01771
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
156106001
—
AR
Enumeration date
09/13/2006
Last updated
07/22/2016
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