Organization
WESLEY R WEDNER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WES WEDNER (OWNER)
(360) 661-2088
Entity
Organization
Contact information
Practice address
17888 W BIG LAKE BLVD, MOUNT VERNON, WA 98274-8387
(360) 734-6849
Mailing address
PO BOX 988, BURLINGTON, WA 98233-0637
(360) 734-6849
Taxonomy
Speciality
Code
Description
License number
State
335V00000X
Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
Primary
08655
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
204961204961
PREMERA PROVIDER NUMBER
WA
01
—
43340900O2
GHC PROVIDER ID NUMBER
WA
01
—
649468
STERLING PROVIDER NUMBER
WA
05
—
7095375
—
WA
Enumeration date
07/11/2006
Last updated
07/14/2008
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