WESLEY PHYSICIAN SERVICES LLC NPI 1538200209

NPI Information

NPI: 1538200209
Provider Name: WESLEY PHYSICIAN SERVICES LLC
Classification: Family Medicine - 207Q00000X
Entity Type: Organization

CLIA Number: 25D2266692

Address:
5001 HARDY ST
HATTIESBURG, MS
ZIP 39402
Phone: (601) 268-8155
Get Directions

WESLEY PHYSICIAN SERVICES LLC is a family medicine in Hattiesburg, MS. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. WESLEY PHYSICIAN SERVICES LLC NPI is 1538200209. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

5001 HARDY ST
HATTIESBURG, MS
ZIP 39402-308
Phone: (601) 268-8155
Fax: (601) 261-0508

The provider's authorized official is Jennifer L Jackson .
The authorized official title is Senior Director Provider Enrollment and has the following contact phone number (615) 465-7000.

The CLIA number assigned to this NPI record is 25D2266692 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/8/2007 and was last updated on 6/3/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	Primary
1	103T00000X	Psychologist		No
2	104100000X	Social Worker		No
3	1041C0700X	Social Worker	Clinical	No
4	207QA0401X	Family Medicine	Addiction Medicine	No
5	207R00000X	Internal Medicine		No
6	207RC0000X	Internal Medicine	Cardiovascular Disease	No
7	207RI0011X	Internal Medicine	Interventional Cardiology	No
8	207T00000X	Neurological Surgery		No
9	207UN0901X	Nuclear Medicine	Nuclear Cardiology	No
10	208000000X	Pediatrics		No
11	2080A0000X	Pediatrics	Adolescent Medicine	No
12	2084F0202X	Psychiatry & Neurology	Forensic Psychiatry	No
13	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery)		No
14	101YP2500X	Counselor	Professional	No
15	207Q00000X	Family Medicine		Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	06476518	MEDICAID	MISSISSIPPI
2	07687071	MEDICAID	MISSISSIPPI
3	01080271	MEDICAID	MISSISSIPPI
4	01505019	MEDICAID	MISSISSIPPI
5	01726273	MEDICAID	MISSISSIPPI
6	08955318	MEDICAID	MISSISSIPPI
7	05925779	MEDICAID	MISSISSIPPI
8	04727870	MEDICAID	MISSISSIPPI
9	03277572	MEDICAID	MISSISSIPPI
10	09776308	MEDICAID	MISSISSIPPI
11	08883556	MEDICAID	MISSISSIPPI
12	02606764	MEDICAID	MISSISSIPPI
13	02639565	MEDICAID	MISSISSIPPI
14	09236762	MEDICAID	MISSISSIPPI
15	02706278	MEDICAID	MISSISSIPPI
16	06827312	MEDICAID	MISSISSIPPI
17	07236720	MEDICAID	MISSISSIPPI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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