Healthcare Provider Details

I. General information

NPI: 1205209335
Provider Name (Legal Business Name): WEALCAN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2015
Last Update Date: 12/13/2019
Certification Date: 12/13/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1612 S 4TH ST
LEAVENWORTH KS
66048-3442
US

IV. Provider business mailing address

PO BOX 25214
OVERLAND PARK KS
66225-5214
US

V. Phone/Fax

Practice location:
  • Phone: 913-297-3066
  • Fax: 913-297-3067
Mailing address:
  • Phone: 913-297-3066
  • Fax: 913-297-3067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. KHALIL ELGHARSI
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: C.PED.
Phone: 913-297-3066