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General NPI Number Information
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NPI Number | 1083324735
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Entity Type | Organization
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Legal Business Name | ST. MARY'S HEALTH WAGON
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Dates
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Enumeration Date | 12/02/2022
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Last Update Date | 08/12/2024
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Provider Practice Location Address
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Address Line | 5628 PATRIOT DRIVE
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City | WISE
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State | VA
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Zip | 24293
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Country | US
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Telephone | 276-328-8850
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7070
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City | WISE
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State | VA
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Zip | 24293-7070
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Country | US
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Telephone | 276-328-8850
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | PAULA HILL
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Credential |
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Telephone | 276-337-0331
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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