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ST. MARY'S HEALTH WAGON
NPI 1083324735
Clinic/Center - Dental in Wise, VA

Active since December 02, 2022CLIA 49D1039734 · Waiver
5628 PATRIOT DRIVE, WISE, VA 24293(276) 328-8850 Get Directions Write a Review

NPPES record last updated: August 12, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Aug 12, 2024, Aug 6, 2024, Jul 26, 2024 and 1 more (4 updates tracked since 2022).

About St. Mary's Health Wagon NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ST. MARY'S HEALTH WAGON (NPI 1083324735) is a healthcare organization registered as a dental in Wise, Virginia and active in the NPI registry since December 2022. The organization holds a CLIA Waiver certificate valid through November 5, 2027 and lists Paula Hill, Clinical Director, as its authorized official.

NPPES Registry Identity

NPI1083324735
Entity TypeOrganization
Primary Taxonomy261QD0000X
Legal Business NameST. MARY'S HEALTH WAGON
Location Address5628 PATRIOT DRIVEWise, VA 24293
Mailing AddressPo Box 7070Wise, VA 24293-7070 · (276) 328-8850
Phone(276) 328-8850
Organization SubpartNo
Authorized OfficialPaula HillClinical Director · (276) 337-0331
Enumeration DateDecember 2, 2022
Last NPPES UpdateAugust 12, 20244 updates tracked since enumeration
NPPES CertifiedAugust 12, 2024
✔ NPI 1083324735 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · DentalAmbulatory Health Care Facilities
Taxonomy Code261QD0000X
5628 PATRIOT DRIVE, Wise, VA 24293
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CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 49D1039734

St Marys Health Wagon, Inc · Wise, VA
Active · expires Nov 5, 2027
CLIA Number49D1039734
Laboratory TypePhysician Office
Certificate Effective DateNovember 6, 2025
Certificate Expiration DateNovember 5, 2027
Laboratory DirectorTeresa L. Tyson
Laboratory Phone(276) 328-8850
Laboratory LocationSt Marys Health Wagon, Inc5626 Patriot Drive, Wise, VA 24293
CLIA data matches this NPI record on: Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is St. Mary's Health Wagon's NPI number?

The NPI number for St. Mary's Health Wagon is 1083324735. It was assigned to this organization in the NPPES registry on December 2, 2022.

Where is St. Mary's Health Wagon located?

St. Mary's Health Wagon is located at 5628 Patriot Drive, Wise, VA 24293. The listed phone number is (276) 328-8850.

What is St. Mary's Health Wagon's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Dental, with taxonomy code 261QD0000X.

Does St. Mary's Health Wagon hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 49D1039734) is associated with this NPI, valid through November 5, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for St. Mary's Health Wagon was last updated on August 12, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 23 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.