NPIViewer - Provider NPI 1447299649

NPI:	1447299649
Name:	WESLEY MEDICAL CENTER LLC
Entity type:	Organization
Organization Name:	WESLEY MEDICAL CENTER LLC
Other - Org Name:	<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:	CFO
Authorized Official - Prefix:
Authorized Official - First Name:	NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:	CASTLEBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:	316-962-2055
Mailing Address - Street 1:	550 N HILLSIDE ST
Mailing Address - Street 2:
Mailing Address - City:	WICHITA
Mailing Address - State:	KS
Mailing Address - Zip Code:	67214-4910
Mailing Address - Country:	US
Mailing Address - Phone:	316-962-2000
Mailing Address - Fax:	316-688-7093
Practice Address - Street 1:	550 N HILLSIDE ST
Practice Address - Street 2:
Practice Address - City:	WICHITA
Practice Address - State:	KS
Practice Address - Zip Code:	67214-4910
Practice Address - Country:	US
Practice Address - Phone:	316-962-2000
Practice Address - Fax:	316-688-7093
EIN:	<UNAVAIL>
Is Organization Subpart?:	No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:	2006-06-05
Last Update Date:	2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:

Primary?	Code	Type	Classification	Specialization
Yes	282N00000X	Hospitals	General Acute Care Hospital

State	Identifier ID	ID Type	Issuer
TN	00008620	Medicaid
MS	00095932	Medicaid
NM	000B3174	Medicaid
NV	100505041	Medicaid
WY	114142200	Medicaid
NC	1700123	Medicaid
IN	200058970A	Medicaid
ME	403730000	Medicaid
NJ	7932103	Medicaid
FL	900566800	Medicaid
NY	01616031	Medicaid
IA	0524538	Medicaid
	351757100	Other	DEPT OF LABOR
AZ	455586	Medicaid
WA	3021888	Medicaid
MT	416455	Medicaid
VA	010035074	Medicaid
OK	100698010A	Medicaid
HI	5654901	Medicaid
TX	072051801	Medicaid
MN	259548600	Medicaid
MI	304672593	Medicaid
AK	HS9KSIP	Medicaid
OH	0219169	Medicaid
KS	100327110A	Medicaid
OR	155978	Medicaid
LA	1702625	Medicaid
SD	5524520	Medicaid
WI	81565900	Medicaid
AL	WES0123N	Medicaid
CA	XHSP32787	Medicaid
GA	000166757X	Medicaid
MO	010855203	Medicaid
NY	100505041	Medicaid
AR	136562105	Medicaid
	48	Other	BLUE CROSS
ID	805643700	Medicaid
CO	92557767	Medicaid
WA	3021888	Medicaid
FL	900566800	Medicaid
AK	HS9KSIP	Medicaid
AK	HS9KSIP	Medicaid