Provider Demographics
NPI:1467460030
Name:WESLEY CATH LAB LLC
Entity type:Organization
Organization Name:WESLEY CATH LAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:BUSATTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-962-2204
Mailing Address - Street 1:551 N HILLSIDE ST
Mailing Address - Street 2:SUITE 310
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-4923
Mailing Address - Country:US
Mailing Address - Phone:316-962-7004
Mailing Address - Fax:316-962-7006
Practice Address - Street 1:551 N HILLSIDE ST
Practice Address - Street 2:SUITE 310
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-4923
Practice Address - Country:US
Practice Address - Phone:316-962-7004
Practice Address - Fax:316-962-7006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty