| T W Wagner Inc | |
|
730 Greenwood Ave Lepanto AR 72354-3215 | |
| (870) 475-3825 | |
| Not Available |
| Full Name | T W Wagner Inc |
|---|---|
| Speciality | Clinic/center - Rural Health |
| Location | 730 Greenwood Ave, Lepanto, Arkansas |
| Authorized Official Name and Position | Tommy W Wagner (OWNER/OPERATOR) |
| Authorized Official Contact | 8705613300 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| T W Wagner Inc Po Box 910 Manila AR 72442-0910 Ph: (870) 561-3300 | T W Wagner Inc 730 Greenwood Ave Lepanto AR 72354-3215 Ph: (870) 475-3825 |
| NPI Number | 1114734969 |
|---|---|
| Provider Enumeration Date | 12/16/2024 |
| Last Update Date | 12/19/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114734969 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
East Arkansas Family Health Center Inc. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 102 West Broad, Lepanto, AR 72354 Phone: 870-475-2977 Fax: 870-475-3440 |