Provider Demographics
NPI:1225372014
Name:WESLEY HEALTHCARE PRODUCTS
Entity type:Organization
Organization Name:WESLEY HEALTHCARE PRODUCTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SEBRIAN
Authorized Official - Middle Name:BENNY
Authorized Official - Last Name:WESLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-204-0502
Mailing Address - Street 1:11855 W. BYRON WOLFE DRIVE
Mailing Address - Street 2:
Mailing Address - City:MARANA
Mailing Address - State:AZ
Mailing Address - Zip Code:85653
Mailing Address - Country:US
Mailing Address - Phone:520-204-0502
Mailing Address - Fax:520-616-0550
Practice Address - Street 1:11855 W BYRON WOLFE DR
Practice Address - Street 2:
Practice Address - City:MARANA
Practice Address - State:AZ
Practice Address - Zip Code:85653-7807
Practice Address - Country:US
Practice Address - Phone:520-204-0502
Practice Address - Fax:520-616-0550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20892219332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies