Wagoner Medical Group PC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

WAGONER MEDICAL GROUP PC

Practice address

800 N Alpha St
Grand Island, NE 68803-4320

Phone

(308) 382-2010

Fax

(308) 382-9549

NPI assigned

May 27, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Jody M Hughes, RN

Title

Office Manager

Phone

(308) 382-2010

Specialties & licenses 2

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1203033600000",
    "number": "1013964162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 N ALPHA ST",
            "city": "GRAND ISLAND",
            "state": "NE",
            "postal_code": "688034320",
            "telephone_number": "308-382-2010",
            "fax_number": "308-382-9549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 N ALPHA ST",
            "city": "GRAND ISLAND",
            "state": "NE",
            "postal_code": "688034320",
            "telephone_number": "308-382-2010",
            "fax_number": "308-382-9549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAGONER MEDICAL GROUP PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-27",
        "last_updated": "2008-02-15",
        "status": "A",
        "authorized_official_last_name": "HUGHES",
        "authorized_official_first_name": "JODY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "308-382-2010",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "NE",
            "license": null,
            "primary": true
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": "NE",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP RAILROAD",
            "identifier": "CD3724",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Connie Waage
• Patricia Elaine Waage
• Richard K Waggoner, P.A.-C
• Becky Wagner
• Gretchen Lee Wagner, LIMHP
• John A Wagoner, M.D.
• Shirley Wahlgren, RN
• Rhonda Kay Wahls, RN
• Ryan T Waind, D.C.
• Wal-Mart Stores, Inc. (Vision Center 30-3395)

• Internal Medicine Physician in Grand Island, NE
• Providers in Grand Island, NE by specialty
• Internal Medicine Physician in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.