Clarence Edward Wesley, PERSONAL PROVIDER

Primary specialty

Physical Disabilities Residential Treatment FacilityTaxonomy code 320700000X

Practice address

2539 Galts Mill Rd
2539 Galts Mill Rd
Madison Heights, VA 24572-5808

Phone

(434) 316-4778

Fax

(434) 845-0856

NPI assigned

Dec 30, 2011

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1325203200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1325203200000",
    "number": "1184994675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2539 GALTS MILL RD",
            "city": "MADISON HEIGHTS",
            "state": "VA",
            "postal_code": "245725808",
            "telephone_number": "434-316-4778",
            "fax_number": "434-845-0856"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2539 GALTS MILL RD",
            "address_2": "2539 GALTS MILL RD",
            "city": "MADISON HEIGHTS",
            "state": "VA",
            "postal_code": "245725808",
            "telephone_number": "434-316-4778",
            "fax_number": "434-845-0856"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WESLEY",
        "first_name": "CLARENCE",
        "middle_name": "EDWARD",
        "name_prefix": "Mr.",
        "credential": "PERSONAL PROVIDER",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-12-30",
        "last_updated": "2011-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "320700000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Physical Disabilities",
            "state": "VA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Disabilities Residential Treatment Facility in Madison Heights, VA
• Providers in Madison Heights, VA by specialty
• Physical Disabilities Residential Treatment Facility in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.