James S Wagenaar
Emergency Physician Emergency Medical Services
1408 Campbell Dr
Ironton
, Ohio 45638-2301
James S Wagenaar
Emergency Physician Emergency Medical Services
1408 Campbell Dr
Ironton
, Ohio 45638-2301
(740) 553-9712
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About
Features
Specialties
- Emergency Physician
- Emergency Medical Services
Languages spoken
- English
Location
First Address
- James S Wagenaar
- 1408 Campbell Dr
- Ironton, OH
- Zip : 45638-2301
- Fax : (740) 553-9712
- Phone : (740) 533-9710
Second Address
- James S Wagenaar
- 1408 Campbell Dr
- Ironton, OH
- Zip : 45638-2301
- Fax : (740) 533-9712
- Phone : (740) 533-9710
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207P00000X | Emergency Physician | 34005359 | OH |
| N | 207PE0004X | Emergency Medical Services | 34005359 | OH |
National Provider Identifier
| NPI | 1194768754 |
|---|---|
| Provider Name | James S Wagenaar |
| First Address | Ironton, OH 45638-2301 |
| Second Address | Ironton, OH 45638-2301 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 13/06/2006 |
| Last Update Date | 29/10/2020 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 000000210197 | OH MEDICAID UNISON (01) | OH |
| 000000493481 | ANTHEM BCBS (01) | |
| 000702618 | MOUNTAIN STATE BCBS (01) | |
| 0043615000 | (05) | WV |
| 0843529 | (05) | OH |
| 310917085154 | OH MEDICAID CARESOURCE (01) | OH |
| E99199 | (02) |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.