| Organization Name: | WAGNER COMMUNITY MEMORIAL HOSPITAL |
| NPI Number: | 1740306992 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BERNADETTE R KOUPAL (BUS. OFFICE MANAGER) |
| Mailing Address: | 513 3rd St Sw Wagner |
| State: | SD US |
| Postal Code: | 573809675 |
| Phone Number: | 6053843418 |
| Fax Number: | 6053845240 |
| NPI Enumeration Date: | 03/21/2007 |
| NPI Last Update Date: | 02/24/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 10571 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | SD |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |