Wagoner Medical Center, LLC

NPI #1194940080 in Kokomo, Indiana

Provider Information

NPI Number: 1194940080
Entity Type: Organization
Organization Name: Wagoner Medical Center, LLC
Primary Specialty: Family Medicine
Enumeration Date: Apr 16, 2007
Last Updated: May 15, 2009

Practice Location

Address: 821 N DIXON RD
City: Kokomo
State: Indiana
ZIP Code: 46901-1754
Phone: (765) 452-0878

Authorized Official

Name: MICHELLE WAGONER
Title: ADMINISTRATOR
Phone: (765) 566-3303

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Internal Medicine	207R00000X
Family Medicine	207Q00000X	Primary

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