Michael Waggoner Od Pa

LBN: Michael Waggoner Od Pa
Michael Waggoner Od Pa is an health care organization with primary practice located at 2630 E Citizens Dr Ste 6 , Fayetteville AR 72703-4797. The organization recently has only one registered license in Managed Care Organizations / Health Maintenance Organization, which is considered as the primary health care specialty. Michael Waggoner Od Pa can be contacted via phone (479) 582-1212, or through Waggoner, Michael via phone (479) 582-1212.

Contact Information

Primary practice address
2630 E Citizens Dr Ste 6 Fayetteville AR 72703-4797
Phone: (479) 582-1212
Fax: (479) 582-2070
Website:
Map and Directions
Authorized official contact:
Name: Waggoner, Michael
Phone: (479) 582-1212

Health care specialties

SpecialtyCodeLicense #State
Managed Care Organizations / Health Maintenance Organization 302R00000X 2411 Arkansas

Profile Details

NPI number 1992021190
LBN Legal business name Michael Waggoner Od Pa
DBA Doing business as
Authorized official Waggoner, Michael
Entity Organization
Organization subpart 1 No
Enumeration date Apr 13th, 2010
Last updated Aug 12th, 2015 - about 10 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1992021190 NPPES
Arkansas Other 1639185341 NPI
Arkansas Other 5G500 NPI
Arkansas MEDICAID 127297722 NPI
Arkansas Other 1992021190 NPI

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