| Dr Jack Wagoner, MD | |
|
205 N East Ave, Jackson, MI 49201-1753 | |
| (517) 788-4963 | |
| (517) 789-5903 |
| Full Name | Dr Jack Wagoner |
|---|---|
| Gender | Male |
| Speciality | Anesthesiology |
| Experience | 39 Years |
| Location | 205 N East Ave, Jackson, Michigan |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598700072 | NPI | - | NPPES |
| 2737106 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207L00000X | Anesthesiology | 4301-407025 (Michigan) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Forest Health Medical Center | Ypsilanti, MI | Hospital |
| St Joseph Mercy Chelsea | Chelsea, MI | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Anesthesia Associates Of Ann Arbor Pllc | 1355317223 | 202 |
| Entity Name | Anesthesia Associates Of Ann Arbor Pllc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1669581997 PECOS PAC ID: 1355317223 Enrollment ID: O20040902000916 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Jack Wagoner, MD 205 N East Ave, Jackson, MI 49201-1753 Ph: (517) 788-4963 | Dr Jack Wagoner, MD 205 N East Ave, Jackson, MI 49201-1753 Ph: (517) 788-4963 |
Dr. Melinda Mitchell, MD Anesthesiology Medicare: Accepting Medicare Assignments Practice Location: 205 N East Ave, Jackson, MI 49201 Phone: 517-205-7836 | |
Clemon Pardales, D.O. Anesthesiology Medicare: Not Enrolled in Medicare Practice Location: 2775 Blake Rd, Jackson, MI 49201 Phone: 517-787-2906 Fax: 517-787-3039 | |
Dr. Vinay Anad-raj Pallekonda, M.D. Anesthesiology Medicare: Accepting Medicare Assignments Practice Location: 255 W Michigan Ave, Jackson, MI 49201 Phone: 517-787-6440 Fax: 517-787-7230 | |
Dr. Daniel Robert Grutter, D.O. Anesthesiology Medicare: Accepting Medicare Assignments Practice Location: 205 North East Ave, Anesthesia Department, Jackson, MI 49201 Phone: 517-205-3240 | |
Dr. Yung I Park, M.D. Anesthesiology Medicare: Accepting Medicare Assignments Practice Location: 255 W Michigan Ave, Jackson, MI 49201 Phone: 517-787-6440 Fax: 517-787-4146 | |
Nicole M Horning, Anesthesiology Medicare: Accepting Medicare Assignments Practice Location: 205 N East Ave, Jackson, MI 49201 Phone: 517-205-4800 | |
Doris P Cralle, M.D Anesthesiology Medicare: Accepting Medicare Assignments Practice Location: 744 W Michigan Ave, Jackson, MI 49201 Phone: 517-787-6440 Fax: 517-787-4146 |