MEDICARE: WESLEY & KLIPPENSTEIN, PC

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	261QA1903X	Ambulatory Surgical Clinic/Center
2	261QA1903X	Ambulatory Surgical Clinic/Center	0000000072	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1000929	OTHER	TN	BCBS PROVIDER ID#

General Provider Information

NPI Number	:	1679521389
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESLEY & KLIPPENSTEIN, PC

Provider Business Mailing Address
First Line	:	1800 CHURCH ST
Second Line	:	SUITE 100
City	:	NASHVILLE
State	:	TN
Zip	:	37203-2233
Country	:	US
Telephone Number	:	615-329-3624
Fax Number	:	615-329-0639

Provider Business Practice Location Address
First Line	:	1800 CHURCH ST.
Second Line	:	SUITE 150
City	:	NASHVILLE
State	:	TN
Zip	:	37203-2233
Country	:	US
Telephone Number	:	615-329-3624
Fax Number	:	615-329-0639

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RALPH E. WESLEY
Credential	:	M.D.
Telephone Number	:	615-329-3624

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	06/28/2021

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