=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225372014
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WESLEY HEALTHCARE PRODUCTS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/16/2012
-----------------------------------------------------
Last Update Date | 11/16/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11855 W BYRON WOLFE DR
-----------------------------------------------------
City | MARANA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85653-7807
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-204-0502
-----------------------------------------------------
Fax | 520-616-0550
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11855 W. BYRON WOLFE DRIVE
-----------------------------------------------------
City | MARANA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85653
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-204-0502
-----------------------------------------------------
Fax | 520-616-0550
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. SEBRIAN BENNY WESLEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 520-204-0502
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 20892219
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------