Michael Waggoner OD PA

Primary specialty

Health Maintenance OrganizationTaxonomy code 302R00000X

License

2411 Issued in AR

Legal business name

MICHAEL WAGGONER OD PA

Practice address

2630 E Citizens Dr Ste 6
Fayetteville, AR 72703-4797

Phone

(479) 582-1212

Fax

(479) 582-2070

NPI assigned

Apr 13, 2010

Organization subpart

No

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

Authorized official

Name

Michael Waggoner

Title

Owner

Phone

(479) 582-1212

Specialties & licenses 1

Addresses

Other identifiers 4

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Brock Johnson, DC

  • Chiropractor
  • Fayetteville, AR
  • NPI 1992197180
  NPD

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

{
    "created_epoch": "1271116800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1439337600000",
    "number": "1992021190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2630 E CITIZENS DR STE 6",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727034797",
            "telephone_number": "479-582-1212",
            "fax_number": "479-582-2070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2630 E CITIZENS DR STE 6",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727034797",
            "telephone_number": "479-582-1212",
            "fax_number": "479-582-2070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL WAGGONER OD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-13",
        "last_updated": "2015-08-12",
        "status": "A",
        "authorized_official_last_name": "WAGGONER",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "479-582-1212"
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": "AR",
            "license": "2411",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1639185341",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP PTAN",
            "identifier": "5G500",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "127297722",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI",
            "identifier": "1992021190",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kaidenn Meyers
• Madison Marie Meyers, LCSW
• Erika Meza, APRN
• Amanda Mhoon
• Michael Schwarz LPC PLLC
• Kiera Camille Michailoff-Russell, LPC
• Sophia J Michalak, LPC
• Desiree Carolina Middlebrook
• Anthony David Middleton
• Midtown Counseling

• Health Maintenance Organization in Fayetteville, AR
• Providers in Fayetteville, AR by specialty
• Health Maintenance Organization in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2015; 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.