Provider Demographics
NPI:1730586736
Name:WINNER SURGERY CLINIC, P.C.
Entity type:Organization
Organization Name:WINNER SURGERY CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:605-842-1612
Mailing Address - Street 1:825 E 8TH ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WINNER
Mailing Address - State:SD
Mailing Address - Zip Code:57580-2634
Mailing Address - Country:US
Mailing Address - Phone:605-842-1612
Mailing Address - Fax:605-842-3837
Practice Address - Street 1:825 E 8TH ST
Practice Address - Street 2:SUITE 202
Practice Address - City:WINNER
Practice Address - State:SD
Practice Address - Zip Code:57580-2634
Practice Address - Country:US
Practice Address - Phone:605-842-1612
Practice Address - Fax:605-842-3837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-20
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDDB059482208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty