1972658144 NPI number — WESLEY SPECTRUM SERVICES

Table of content: (NPI 1972658144)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972658144 NPI number — WESLEY SPECTRUM SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WESLEY SPECTRUM SERVICES
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:
THE WESLEY INSTITUTE
Provider Other Organization Name Type Code:
4
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:
1972658144
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
243 JOHNSTON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UPPER SAINT CLAIR
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15241-2534
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-831-9390
Provider Business Mailing Address Fax Number:
412-831-8868

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5250 CASTE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15236-1502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-831-9390
Provider Business Practice Location Address Fax Number:
412-831-8868
Provider Enumeration Date:
01/25/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MUETZEL
Authorized Official First Name:
DOUG
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
412-831-9390

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  422720 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YS0200X , with the licence number: 422720 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251300000X , with the licence number: 422720 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0855X , with the licence number: 422720 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1001340160011 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 329484A847396 . This is a "VBH OF PA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1001340160004 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".