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General NPI Number Information
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NPI Number | 1326030974
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Entity Type | Organization
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Legal Business Name | WAGNER COMMUNITY MEMORIAL HOSPITAL
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Dates
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Enumeration Date | 08/19/2005
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Last Update Date | 03/07/2017
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Provider Practice Location Address
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Address Line | 513 3RD ST SW
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City | WAGNER
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State | SD
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Zip | 57380-9675
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Country | US
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Telephone | 605-384-3611
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Fax | 605-384-3232
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Provider Business Mailing Address
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Address Line | 513 3RD ST SW
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City | WAGNER
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State | SD
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Zip | 57380-9675
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Country | US
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Telephone | 605-384-3611
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Fax | 605-384-3232
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Authorized Official
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Title or Position | CEO
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Name | MR. BRYAN SLABA
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Credential |
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Telephone | 605-384-3611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NC0060X
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Taxonomy Name | Critical Access Hospital
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License Number | 10571
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License Number State | SD
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