| T W Wagner Inc | |
|
3644 W State Highway 18 Manila AR 72442-8049 | |
| (870) 561-3300 | |
| (870) 561-3307 |
| Full Name | T W Wagner Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 3644 W State Highway 18, Manila, Arkansas |
| Authorized Official Name and Position | Tommy W Wagner (OWNER) |
| Authorized Official Contact | 8705613300 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| T W Wagner Inc Po Box 910 Manila AR 72442-0910 Ph: (870) 561-3300 | T W Wagner Inc 3644 W State Highway 18 Manila AR 72442-8049 Ph: (870) 561-3300 |
| NPI Number | 1548244171 |
|---|---|
| Provider Enumeration Date | 12/06/2005 |
| Last Update Date | 07/22/2016 |
| Medicare PECOS PAC ID | 1153359096 |
|---|---|
| Medicare Enrollment ID | O20050801000974 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548244171 | NPI | - | NPPES |
| 157742729 | Medicaid | AR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Shaneyfelt Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 105 S. Baltimore, Manila, AR 72442 Phone: 870-561-4421 Fax: 870-561-3434 | |
Wagner Medical Clinic Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 3644 W State Highway 18, Manila, AR 72442 Phone: 870-561-3300 Fax: 870-561-3307 |