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General NPI Number Information
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NPI Number | 1841805306
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Entity Type | Organization
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Legal Business Name | ALEX WAGNER, LLC
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Dates
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Enumeration Date | 09/11/2020
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Last Update Date | 09/15/2020
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Provider Practice Location Address
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Address Line | 1864 LAKESHORE DR STE A
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City | MUSKEGON
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State | MI
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Zip | 49441-1607
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Country | US
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Telephone | 231-755-1648
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Fax | 231-755-5279
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Provider Business Mailing Address
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Address Line | 1864 LAKESHORE DR STE A
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City | MUSKEGON
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State | MI
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Zip | 49441-1607
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Country | US
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Telephone | 231-755-1648
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Fax | 231-755-5279
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | TRACEY GABLE-PIPER
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Credential | CPC
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Telephone | 231-755-3647
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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