Victor S Wagner, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6301008134 Issued in MI

Practice address

Mecosta County Medical Center
605 Oak Street
Big Rapids, MI 49307

Phone

(231) 592-4444

NPI assigned

Jul 7, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Advantage Health Physicians PC

  • Family Medicine Physician
  • Grand Rapids, MI
  • NPI 1386695252
  NPD (past)
• Advantage Health Saint Mary'S Medical Group

  • Orthopaedic Surgery Physician
  • Byron Center, MI
  • NPI 1003515008
  NPD (past)
• Life Guidance Services

  • Social Worker
  • Grand Rapids, MI
  • NPI 1336185032
  NPD (past)
• Project Rehab

  • Substance Abuse Rehabilitation Facility
  • Grand Rapids, MI
  • NPI 1104986603
  NPD (past)
• Rite Aid of Michigan Inc

  • Community/Retail Pharmacy
  • Washington, MI
  • NPI 1619117405
  NPD (past)
• Rite Aid of Michigan Inc

  • Community/Retail Pharmacy
  • Grand Rapids, MI
  • NPI 1811910722
  NPD (past)

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

{
    "created_epoch": "1152230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1204848000000",
    "number": "1457383820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "858 PINECREST AVE SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495063435",
            "telephone_number": "616-719-6208"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "MECOSTA COUNTY MEDICAL CENTER",
            "address_2": "605 OAK STREET",
            "city": "BIG RAPIDS",
            "state": "MI",
            "postal_code": "49307",
            "telephone_number": "231-592-4444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "VICTOR",
        "middle_name": "S",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-07",
        "last_updated": "2008-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301008134",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Janet Lynn Vizina-Roubal, LMSW
• Cassandra Marie Dobbins Vogel, MD
• Harrison Scott Vogel, D.O.
• Sarah Elizabeth Vruwink, MA, CCC-SLP
• Kelly Wagenheim
• Wal-Mart Stores East LP
• Wal-Mart Stores East, LP
• Walgreen Co
• Philip E Walling, OD
• Jessica Walsh

• Clinical Psychologist in Big Rapids, MI
• Providers in Big Rapids, MI by specialty
• Clinical Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 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.