Healthcare Provider Details

I. General information

NPI: 1275154619
Provider Name (Legal Business Name): WESLEY HEALTH SYSTEM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2020
Last Update Date: 04/27/2020
Certification Date: 04/27/2020
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:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: JAMES P WRIGHT
Title or Position: VP PHYSICIAN BUSINESS SERVICES
Credential:
Phone: 615-778-1502