| Wagner Indian Health Service Health Center | |
|
111 Washington Ave Wagner SD 57380 | |
| (605) 384-3621 | |
| (605) 384-3293 |
| Full Name | Wagner Indian Health Service Health Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 111 Washington Ave, Wagner, South Dakota |
| Authorized Official Name and Position | Michael Horned Eagle (CEO) |
| Authorized Official Contact | 6053843621 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wagner Indian Health Service Health Center 111 Washington Ave Wagner SD 57380 Ph: (605) 384-3621 | Wagner Indian Health Service Health Center 111 Washington Ave Wagner SD 57380 Ph: (605) 384-3621 |
| NPI Number | 1326066796 |
|---|---|
| Provider Enumeration Date | 07/17/2006 |
| Last Update Date | 11/20/2009 |
| Medicare PECOS PAC ID | 6305758483 |
|---|---|
| Medicare Enrollment ID | O20031105000746 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326066796 | NPI | - | NPPES |
| 5540030 | Medicaid | SD | |
| 5540280 | Medicaid | SD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Julie K Williams |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1679653208 PECOS PAC ID: 8426002809 Enrollment ID: I20050309000122 |
| Provider Name | Tamara Wheeler |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1114085693 PECOS PAC ID: 8628116571 Enrollment ID: I20091112000587 |
| Provider Name | Jeffrey Charles Wienke |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1629207261 PECOS PAC ID: 3173779212 Enrollment ID: I20140331000727 |
| Provider Name | Antonio C Padilla Cedo |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1023342409 PECOS PAC ID: 2961535539 Enrollment ID: I20160104002061 |
| Provider Name | Melody J Otte |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649686080 PECOS PAC ID: 0941428445 Enrollment ID: I20161116002632 |
| Provider Name | Blandine Pierre |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1558887612 PECOS PAC ID: 1052675865 Enrollment ID: I20180502002785 |
| Provider Name | Aimy I Mahony |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992217988 PECOS PAC ID: 5193081883 Enrollment ID: I20190319000923 |
| Provider Name | Christine M Kayl |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1982904660 PECOS PAC ID: 4981935210 Enrollment ID: I20191017000251 |
| Provider Name | Karrah A Johnson Bruegman |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1821656349 PECOS PAC ID: 0840697900 Enrollment ID: I20210916002189 |
| Provider Name | Vicki R Lubbers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629461520 PECOS PAC ID: 7416277413 Enrollment ID: I20210917002552 |
| Provider Name | Carmen R Rodriguez Ruiz |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1619170842 PECOS PAC ID: 7113312109 Enrollment ID: I20220309001066 |
| Provider Name | Colleen L Campbell-lane |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1750523395 PECOS PAC ID: 7618006743 Enrollment ID: I20220921001068 |
| Provider Name | Christine D Manns |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932516705 PECOS PAC ID: 3173993748 Enrollment ID: I20221227000219 |
| Provider Name | Monay D Wadsworth |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1912589441 PECOS PAC ID: 1153796636 Enrollment ID: I20230414001618 |
| Provider Name | Emma M Bye |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1316432271 PECOS PAC ID: 0244581627 Enrollment ID: I20230510001355 |
| Provider Name | Kenzie S Gant |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750001970 PECOS PAC ID: 6709242969 Enrollment ID: I20230515001945 |
| Provider Name | Deborah J Gross |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1649305087 PECOS PAC ID: 1557328788 Enrollment ID: I20230821003472 |
| Provider Name | Kristina N Huckstep |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1114420643 PECOS PAC ID: 8325469299 Enrollment ID: I20231218000581 |
| Provider Name | Vanessa J Iverson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1679044663 PECOS PAC ID: 7810388485 Enrollment ID: I20240320000169 |
| Provider Name | Jennifer K Noteboom |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1215682133 PECOS PAC ID: 2769829266 Enrollment ID: I20240320000475 |
Prairie Health Clinic Wagner Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 310 W Sd Highway 46, Wagner, SD 57380 Phone: 605-724-2151 | |
Wagner Community Clinic Avera Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 513 3rd St Sw, Wagner, SD 57380 Phone: 605-384-3418 Fax: 605-384-5240 |