Healthcare Provider Details

I. General information

NPI: 1841241841
Provider Name (Legal Business Name): WESLEY HEALTH SYSTEM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2006
Last Update Date: 04/22/2021
Certification Date: 04/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5001 HARDY ST
HATTIESBURG MS
39402-1308
US

IV. Provider business mailing address

PO BOX 848488
DALLAS TX
75284-8488
US

V. Phone/Fax

Practice location:
  • Phone: 601-268-8000
  • Fax: 601-268-5008
Mailing address:
  • Phone: 601-268-8000
  • Fax: 601-268-5008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number12-023
License Number StateMS

VIII. Authorized Official

Name: PAULA M LALOR
Title or Position: DIRECTOR/DELEGATED OFFICIAL
Credential:
Phone: 629-215-3953