T W WAGNER INC (NPI# 1316041957) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316041957 |
| Entity Type | Organization |
| Organization Name | T W WAGNER INC |
| Other Organization Name | WAGNER MEDICAL CLINIC |
| Practice Address |
331 Broad Street Suite B Lepanto AR 72354 |
| Practice Telephone | 8704753825 |
| Practice Fax Number | 8704753823 |
| Mailing Telephone | 8704753825 |
| Mailing Fax Number | 8704753823 |
| Enumeration Date | 2006-09-12 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | TOMMY W WAGNER JR. (OWNER) |
| Authorized Official Telephone | 8705613300 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR1300X |
Clinic/Center Specialization: Rural Health |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| WAGNER MEDICAL CLINIC | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548244171 | T W Wagner Inc | Clinic/Center | 3644 W State Highway 18, Manila, AR 72442-8049 | 2005-12-06 |
| 1720183031 | T W Wagner Inc | Nurse Practitioner | 3644 W State Highway 18, Manila, AR 72442-8049 | 2006-09-13 |
| Street Address |
331 BROAD STREET SUITE B |
| City | LEPANTO |
| State | AR |
| Zip Code | 72354 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992298756 | Hannah Nicole Tyler | Case Manager/Care Coordinator | 122 Will Henry Dr., Lepanto, AR 72354 | 2018-06-07 |
| 1295952182 | East Arkansas Family Health Center Inc. | Pharmacy | 102 W Broad, Lepanto, AR 72354 | 2007-04-20 |
| 1922139062 | East Arkansas Family Health Center Inc. | Clinic/Center | 102 West Broad, Lepanto, AR 72354 | 2007-03-08 |
| 1265568745 | Jones Drug Store | Pharmacy | 216 Greenwood Ave South, Lepanto, AR 72354 | 2007-02-26 |
| 1053528778 | Lisa J Booker | Nurse Practitioner | 260 West Broad Street, Lepanto, AR 72354-0000 | 2007-05-16 |
| 1902885015 | Sumner R Cullom | General Practice | 260 W Broad St, Lepanto, AR 72354-0723 | 2006-01-17 |
| 1225373749 | Joseph Daniel Mcguinness | Physician Assistant | 102 W Broad St, Lepanto, AR 72354-2200 | 2012-12-10 |
| 1538444252 | Mike Miller | Pharmacist | 102 W Broad St, Lepanto, AR 72354-2200 | 2011-10-13 |
| 1366608895 | East Arkansas Family Health Center | Dentist | 102 W Broad St, Lepanto, AR 72354-2200 | 2008-08-04 |
| 1114994035 | Kristi Renee Allen | Nurse Practitioner | 102 W Broad St, Lepanto, AR 72354-2200 | 2006-03-01 |
| Find all providers in zip 72354 | ||||
| Taxonomy Code | 261QR1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rural Health |
| Definition to come... |
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| 1124539648 | Access Medical Clinic Arkansas LLC | Clinic/Center | 1016 North Fourche Avenue, Perryville, AR 72126 | 2017-10-24 |
| 1174044697 | Bradley County Medical Center Rural Health Clinic | Clinic/Center | 304 East Central, Warren, AR 71671-0000 | 2017-07-06 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.