Organization
MIDSTATE MEDICAL SERVICES PA
Active
Organization
MIDSTATE MEDICAL SERVICES PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM GLYN WAGNON MD (OWNER)
(501) 525-5840
Entity
Organization
Contact information
Practice address
3810 CENTRAL AVE, SUITE H, HOT SPRINGS, AR 71913-6921
(501) 525-5840
(501) 525-1762
Mailing address
3810 CENTRAL AVE, SUITE H, HOT SPRINGS, AR 71913-6921
(501) 525-5840
(501) 525-1762
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
MC1263
AR
Other
Enumeration date
07/26/2006
Last updated
08/22/2020
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