MEDICARE: MS. JONI WAGNER PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	0481	SD

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	S1639	OTHER	SD	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01-11971	OTHER	SD	MEDICA
3	2843	OTHER	SD	AVERA HEALTH
4	234724	OTHER	SD	MIDLAND'S CHOICE
5	9238086	OTHER	SD	DAKOTACARE
6	HP34870	OTHER	SD	HEALTH PARTNERS
7	4997236	OTHER	SD	WELLMARK
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	AH1311029419	OTHER	SD	PREFERRED ONE

General Provider Information

NPI Number	:	1992775027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JONI WAGNER PA-C

Provider Business Mailing Address
First Line	:	PO BOX 86430
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57118-6430
Country	:	US
Telephone Number	:	605-322-4900
Fax Number	:	605-322-4925

Provider Business Practice Location Address
First Line	:	740 S HILL ST
Second Line	:
City	:	SALEM
State	:	SD
Zip	:	57058-8760
Country	:	US
Telephone Number	:	605-425-2855
Fax Number	:	605-425-2149

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	12/27/2017

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Directions to “ MS. JONI WAGNER PA-C” Practice Location

Language	Start Address	Practice Location

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