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General NPI Number Information
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NPI Number | 1467460030
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Entity Type | Organization
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Legal Business Name | WESLEY CATH LAB LLC
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Dates
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Enumeration Date | 08/03/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 551 N HILLSIDE ST SUITE 310
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City | WICHITA
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State | KS
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Zip | 67214-4923
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Country | US
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Telephone | 316-962-7004
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Fax | 316-962-7006
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Provider Business Mailing Address
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Address Line | 551 N HILLSIDE ST SUITE 310
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City | WICHITA
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State | KS
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Zip | 67214-4923
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Country | US
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Telephone | 316-962-7004
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Fax | 316-962-7006
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Authorized Official
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Title or Position | BOARD MEMBER
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Name | DAVID A. BUSATTI
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Credential |
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Telephone | 316-962-2204
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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