Organization
WESLEY PATHOLOGY CONSULTANTS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DALE GRAHAM (ADMINISTRATOR)
(316) 962-2877
Entity
Organization
Contact information
Practice address
550 N HILLSIDE ST, WICHITA, KS 67214-4910
(316) 685-6112
Mailing address
PO BOX 47340, WICHITA, KS 67201-7340
(316) 685-6112
(316) 652-0343
Taxonomy
Speciality
Code
Description
License number
State
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
016272
BCBS OF KANSAS
KS
01
—
CR0814
RAILROAD MEDICARE
KS
Enumeration date
12/07/2005
Last updated
08/22/2020
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