Healthcare Provider Details

I. General information

NPI: 1770568263
Provider Name (Legal Business Name): WESLEY PATHOLOGY CONSULTANTS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 N HILLSIDE ST
WICHITA KS
67214-4910
US

IV. Provider business mailing address

PO BOX 47340
WICHITA KS
67201-7340
US

V. Phone/Fax

Practice location:
  • Phone: 316-685-6112
  • Fax:
Mailing address:
  • Phone: 316-685-6112
  • Fax: 316-652-0343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DALE GRAHAM
Title or Position: ADMINISTRATOR
Credential:
Phone: 316-962-2877