Wagner Community Memorial Hospital Avera

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

43D0407563 Issued in SD

Legal business name

WAGNER COMMUNITY MEMORIAL HOSPITAL AVERA

Practice address

513 3Rd St SW
Wagner, SD 57380-9675

Phone

(605) 384-3611

Fax

(605) 384-3232

NPI assigned

Jan 11, 2010

Last updated

Jan 11, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Bryan Slaba

Title

Ceo

Phone

(605) 384-3611

Specialties & licenses 1

Addresses

Other names 1

• Wagner Community Clinic Avera Other name

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1263168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1263168000000",
    "number": "1285964494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 280",
            "address_2": "513 3RD ST SW",
            "city": "WAGNER",
            "state": "SD",
            "postal_code": "573800280",
            "telephone_number": "605-384-3611",
            "fax_number": "605-384-3232"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "513 3RD ST SW",
            "city": "WAGNER",
            "state": "SD",
            "postal_code": "573809675",
            "telephone_number": "605-384-3611",
            "fax_number": "605-384-3232"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAGNER COMMUNITY MEMORIAL HOSPITAL AVERA",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-11",
        "last_updated": "2010-01-11",
        "status": "A",
        "authorized_official_last_name": "SLABA",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "605-384-3611",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "SD",
            "license": "43D0407563",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wagner Community Clinic Avera",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Vanessa Iverson, LLC
• Diana Lynn Wackel, RPH
• Wagner Community Memorial Hospital
• Wagner Community Memorial Hospital
• Wagner Community Memorial Hospital
• Wagner Indian Health Care Pharmacy
• Wagner Indian Health Service Health Center
• Wagner Indian Health Service Health Center
• Wagner School District
• WCC-BHS Community Health Worker

• Clinical Medical Laboratory in Wagner, SD
• Providers in Wagner, SD by specialty
• Clinical Medical Laboratory in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.