MEDICARE: WESLEY MRI, ASSOCIATES, LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144280728
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESLEY MRI, ASSOCIATES, LTD

Provider Business Mailing Address
First Line	:	PO BOX 8651
Second Line	:
City	:	GREENVILLE
State	:	TX
Zip	:	75404-8651
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4101 WESLEY ST
Second Line	:	SUITE F
City	:	GREENVILLE
State	:	TX
Zip	:	75401-5635
Country	:	US
Telephone Number	:	469-757-1000
Fax Number	:

Authorized Official
Title or Position	:	OPERATIONS MANAGER
Name	:	PHILIP MALONE
Credential	:
Telephone Number	:	405-321-8125

Provider Enumeration Date	:	03/27/2006
Last Update Date	:	08/22/2020

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1679578082 — PETER F GRAY MD PA
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1194797712 — ELIZABETH J WILEY FNP
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