Healthcare Provider Details

I. General information

NPI: 1912052630
Provider Name (Legal Business Name): WESLEY MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 10/20/2022
Certification Date: 10/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 N HILLSIDE ST BLDG 1 5TH FLOOR
WICHITA KS
67214-4910
US

IV. Provider business mailing address

PO BOX 47490
WICHITA KS
67201-7490
US

V. Phone/Fax

Practice location:
  • Phone: 316-962-7190
  • Fax: 316-962-2152
Mailing address:
  • Phone: 316-962-3150
  • Fax: 316-962-7334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: NICOLE CASTLEBERRY
Title or Position: CFO
Credential:
Phone: 316-962-2055