Provider Demographics
NPI:1184629222
Name:WENSLEY ORTHO LABS, INC
Entity Type:Organization
Organization Name:WENSLEY ORTHO LABS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:M
Authorized Official - Last Name:WENSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PMAC
Authorized Official - Phone:336-659-3595
Mailing Address - Street 1:1531 WESTBROOK PLAZA DR STE K
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-1330
Mailing Address - Country:US
Mailing Address - Phone:336-659-3595
Mailing Address - Fax:336-659-3596
Practice Address - Street 1:1531 WESTBROOK PLAZA DR STE K
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103
Practice Address - Country:US
Practice Address - Phone:336-659-3595
Practice Address - Fax:336-659-3596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0448WOtherBCBS PROVIDER NUMBER
NC7703050Medicaid
NCB3022OtherMEDCOST PROVIDER NUMBER
NC36607OtherPARTNERS PROVIDER NUMBER
NC7795205Medicaid
NC7703050Medicaid