St. Mary's Health Wagon

NPI #1114356037 in Wise, Virginia

Provider Information

NPI Number: 1114356037
Entity Type: Organization
Organization Name: St. Mary's Health Wagon
Primary Specialty: Family Medicine
Enumeration Date: Nov 2, 2013
Last Updated: Nov 2, 2013

Practice Location

Address: 5626 PATRIOT DRIVE
City: Wise
State: Virginia
ZIP Code: 24293-7070
Phone: (276) 328-8850

Authorized Official

Name: MS. TERESA L. GARDNER, D.N.P.
Title: EXECUTIVE DIRECTOR
Phone: (276) 328-8850

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Family Medicine	207Q00000X	Primary

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