Provider Demographics
NPI:1588632145
Name:WESLEY MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:WESLEY MEDICAL CENTER LLC
Other - Org Name:MID-KANSAS INPATIENT PHYSICIANS
Other - Org Type:Doing Business As
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:PO BOX 47490
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67201-7490
Mailing Address - Country:US
Mailing Address - Phone:316-962-3150
Mailing Address - Fax:316-962-7334
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:316-962-2030
Practice Address - Fax:316-962-3056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-09
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100327110IMedicaid
KS110784OtherBLUE CROSS BLUE SHIELD