| NPI | 1740306992 |
|---|---|
| Other Name | WAGNER COMMUNITY CLINIC AVERA |
| Entity Type | Organization |
| Authorized Contact | BERNADETTE R KOUPAL Bus. Office Manager 605-384-3611 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SD 10571) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: SD 10571) |
| 363A00000X Physician Assistant (Licence: SD 10571) | |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2017-03-07 |