Provider Demographics
NPI:1710181482
Name:MYRON WAGNER CO. INC.
Entity Type:Organization
Organization Name:MYRON WAGNER CO. INC.
Other - Org Name:WAGNER QUALITY SHOES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:MYRON
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-682-2759
Mailing Address - Street 1:4313 BUTLER ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15201-3009
Mailing Address - Country:US
Mailing Address - Phone:412-682-2759
Mailing Address - Fax:412-682-3920
Practice Address - Street 1:4313 BUTLER ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15201-3009
Practice Address - Country:US
Practice Address - Phone:412-682-2759
Practice Address - Fax:412-682-3920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA5557170001Medicare NSC