Wagner Community Clinic Avera

LBN: Wagner Community Memorial Hospital
Wagner Community Clinic Avera is an health care organization with primary practice located at 513 3Rd St Sw , Wagner SD 57380-9675. The organization recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, Physician Assistants & Advanced Practice Nursing Providers / Family. Allopathic & Osteopathic Physicians / Family Medicine is the primary health care specialty. Wagner Community Memorial Hospital can be contacted via phone (605) 384-3418, or through Koupal, Bernadette R via phone (605) 384-3611.

Contact Information

Primary practice address
513 3Rd St Sw Wagner SD 57380-9675
Phone: (605) 384-3418
Fax: (605) 384-5240
Website:
Map and Directions
Authorized official contact:
Name: Koupal, Bernadette R
Phone: (605) 384-3611

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 10571 South Dakota
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 10571 South Dakota
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 10571 South Dakota

Profile Details

NPI number 1740306992
LBN Legal business name Wagner Community Memorial Hospital
DBA Doing business as Wagner Community Clinic Avera
Authorized official Koupal, Bernadette R
Entity Organization
Organization subpart 1 No
Enumeration date Mar 21st, 2007
Last updated Mar 7th, 2017 - about 9 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1740306992 NPPES
South Dakota Other S5877 MEDICARE GROUP
South Dakota MEDICAID 1008854 MEDICARE GROUP

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