Healthcare Provider Details

I. General information

NPI: 1467460030
Provider Name (Legal Business Name): WESLEY CATH LAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551 N HILLSIDE ST SUITE 310
WICHITA KS
67214-4923
US

IV. Provider business mailing address

551 N HILLSIDE ST SUITE 310
WICHITA KS
67214-4923
US

V. Phone/Fax

Practice location:
  • Phone: 316-962-7004
  • Fax: 316-962-7006
Mailing address:
  • Phone: 316-962-7004
  • Fax: 316-962-7006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAVID A. BUSATTI
Title or Position: BOARD MEMBER
Credential:
Phone: 316-962-2204