| Wagoner Medical Center, Llc | |
|
821 N Dixon Rd Kokomo IN 46901-1754 | |
| (765) 452-0878 | |
| (765) 566-2250 |
| Full Name | Wagoner Medical Center, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 821 N Dixon Rd, Kokomo, Indiana |
| Authorized Official Name and Position | Michelle Wagoner (ADMINISTRATOR) |
| Authorized Official Contact | 7655663303 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wagoner Medical Center, Llc Po Box 38 Burlington IN 46915-0038 Ph: () - | Wagoner Medical Center, Llc 821 N Dixon Rd Kokomo IN 46901-1754 Ph: (765) 452-0878 |
| NPI Number | 1194940080 |
|---|---|
| Provider Enumeration Date | 04/16/2007 |
| Last Update Date | 05/15/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194940080 | NPI | - | NPPES |
| 200062260C | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
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