1679532949 NPI number — WESSCARE, LLC

Table of content: (NPI 1679532949)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679532949 NPI number — WESSCARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WESSCARE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WESSCARE HOME MEDICAL, LLC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679532949
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7679 HIGHWAY 51 NORTH
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HALLS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38040
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
731-836-1111
Provider Business Mailing Address Fax Number:
731-836-1006

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7730 WOLF RIVER BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GERMANTOWN
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38138-1708
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-245-3150
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
DUSTIN
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
731-445-1852

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  0000002019 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BC3200X , with the licence number: 0000002019 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BD1200X , with the licence number: 0000002019 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BN1400X , with the licence number: 0000002019 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X , with the licence number: 0000002019 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X , with the licence number: 0000002019 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1454940 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 150445 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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