Kenneth W Wagner Sr. (NPI# 1700804309, PAC ID# 4486717923) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is PHYSICIAN ASSISTANT.
| Nation Provider ID (NPI) | 1700804309 |
| PAC ID by PECOS | 4486717923 |
| Professional Enrollment ID | I20090109000633 |
| Full Name | Kenneth W Wagner Sr. |
| Organization Legal Name | EVERGREEN NEUROSURGERY CENTER PLLC |
| Address |
111 Vision Park Blvd Suite 260 Shenandoah TX 77384-3004 |
| Phone Number | 2817199681 |
| Gender | M |
| Graduation Year | 1992 |
| Primary Specialty | PHYSICIAN ASSISTANT |
| Group Practice PAC ID | 8224279351 |
| Number of Group Practice Members | 2 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 450222 | CONROE REGIONAL MEDICAL CENTER |
| 450638 | HOUSTON NORTHWEST MEDICAL CENTER |
| Address | Phone | Organization |
|---|---|---|
| 111 Vision Park Blvd, Suite 260, Shenandoah, TX 77384-3004 | 2817199681 | EVERGREEN NEUROSURGERY CENTER PLLC |
| Organization Legal Name | EVERGREEN NEUROSURGERY CENTER PLLC |
| Physicians | 3 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Travis Lee Lockwood | Physician Assistant | Evergreen Neurosurgery Center Pllc | 111 Vision Park Blvd, Suite 260, Shenandoah, TX 77384-3004 |
| Cyril T Sebastian | Neurosurgery | Evergreen Neurosurgery Center Pllc | 111 Vision Park Blvd, Suite 260, Shenandoah, TX 77384-3004 |
| Street Address |
111 VISION PARK BLVD SUITE 260 |
| City | SHENANDOAH |
| State | TX |
| Zip | 77384-3004 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Michael Sprintz | Anesthesiology | Conroe Ambulatory Anesthesia Pa | 111 Vision Park Blvd, Suite 100, Shenandoah, TX 77384-3003 |
| Anna M Gonzales | Gastroenterology | Digestive Specialists of North Harris County Pa | 111 Vision Park Blvd, Suite 150, Shenandoah, TX 77384-3005 |
| Edward Xavier | Gastroenterology | Digestive Specialists of North Harris County Pa | 111 Vision Park Blvd, Suite 150, Shenandoah, TX 77384-3005 |
| Jamie Respondek-doan | Nurse Practitioner | Digestive Specialists of North Harris County Pa | 111 Vision Park Blvd, Suite 150, Shenandoah, TX 77384-3005 |
| Sarabjeet K Singh | Optometry | Gurpreet Singh Md Pa | 111 Vision Park Blvd, Suite 120, Shenandoah, TX 77384-3003 |
| Travis Lee Lockwood | Physician Assistant | Evergreen Neurosurgery Center Pllc | 111 Vision Park Blvd, Suite 260, Shenandoah, TX 77384-3004 |
| Erica Eunice Jordan | Certified Registered Nurse Anesthetist (crna) | Woodlands Anesthesia Associates LLC | 111 Vision Park Blvd, Suite 160, Shenandoah, TX 77384-3005 |
| Ali T Dural | Gastroenterology | Digestive Specialists of North Harris County Pa | 111 Vision Park Blvd, Suite 150, Shenandoah, TX 77384-3005 |
| Vanitha Bala | Gastroenterology | Digestive Specialists of North Harris County Pa | 111 Vision Park Blvd, Suite 150, Shenandoah, TX 77384-3005 |
| Michael L Blackwell | Orthopedic Surgery | 111 Vision Park Blvd, Suite 100, Shenandoah, TX 77384-3003 | |
| Find all physicians in the same address | |||
| Name | Specialty | Organization | Address |
|---|---|---|---|
| James H Liu | Otolaryngology | 17450 St Lukes Way, Suite 200, The Woodlands, TX 77384-2002 | |
| Krista E Reyes | Audiologist | Adult and Pediatric Ear, Nose, Throat and Allergy of The Woodlands, Pl | 17450 St Lukes Way, Suite 200, The Woodlands, TX 77384-2002 |
| Alix Williamson | Qualified Audiologist | Marquardt Audiology and Hearing Aids Pllc | 17450 St Lukes Way, Suite 150, The Woodlands, TX 77384-2003 |
| Shital S Patel | Qualified Audiologist | Marquardt Audiology and Hearing Aids Pllc | 17450 St Lukes Way, Suite 150, The Woodlands, TX 77384-2003 |
| Meagan S Guidry | Qualified Audiologist | Marquardt Audiology and Hearing Aids Pllc | 17450 St Lukes Way, Suite 150, The Woodlands, TX 77384-2003 |
| Kimberly Menzie | Optometry | Kelsey-seybold Medical Group, Pllc | 106 Vision Park Blvd, Shenandoah, TX 77384-3000 |
| Bret A Mcaden | Internal Medicine | Kelsey-seybold Medical Group, Pllc | 106 Vision Park Blvd, Shenandoah, TX 77384-3000 |
| Srikanth Katragadda | Internal Medicine | Kelsey-seybold Medical Group, Pllc | 106 Vision Park Blvd, Shenandoah, TX 77384-3000 |
| Sujatha Anand | Family Medicine | Kelsey-seybold Medical Group, Pllc | 106 Vision Park Blvd, Shenandoah, TX 77384-3000 |
| Lana Hawayek | Dermatology | Kelsey-seybold Medical Group, Pllc | 106 Vision Park Blvd, Shenandoah, TX 77384-3000 |
| Find all physicians in zip 77384 | |||
| City | SHENANDOAH |
| Zip Code | 77384 |
| Specialty | PHYSICIAN ASSISTANT |
| City + Specialty | SHENANDOAH + PHYSICIAN ASSISTANT |
Please comment or provide details below to improve the information on Kenneth W Wagner Sr..
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.