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NPI Code Detail

MEDICARE: WESLEY COMMUNITY CENTER, INC

MEDICARE: WESLEY COMMUNITY CENTER, INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QF0400XFederally Qualified Health Center (FQHC)

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1144696097
Entity Type Code : Organization
Provider Name (Legal Business Name) : WESLEY COMMUNITY CENTER, INC
Provider Business Mailing Address
First Line : 1300 S 10TH ST
Second Line :
City : PHOENIX
State : AZ
Zip : 85034-4516
Country : US
Telephone Number : 602-368-9603
Fax Number :
Provider Business Practice Location Address
First Line : 1625 N 39TH AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85009-2149
Country : US
Telephone Number : 602-368-9603
Fax Number :
Authorized Official
Title or Position : CHIEF MEDICAL OFFICER
Name : MRS. KATIE BRITE
Credential : M.D.
Telephone Number : 602-368-9603
Provider Enumeration Date : 08/14/2015
Last Update Date : 03/18/2022

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Directions to “WESLEY COMMUNITY CENTER, INC ” Practice Location

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