Provider Demographics
NPI:1255589289
Name:WECARE MEDICAL, LLC
Entity type:Organization
Organization Name:WECARE MEDICAL, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:OLEY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BURGESS
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:606-325-9222
Mailing Address - Street 1:PO BOX 554
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-0554
Mailing Address - Country:US
Mailing Address - Phone:606-325-9222
Mailing Address - Fax:606-920-9425
Practice Address - Street 1:1000 ASHLAND DR
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7084
Practice Address - Country:US
Practice Address - Phone:606-833-2131
Practice Address - Fax:606-833-2130
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WECARE MEDICAL, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-03
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BX2000X
KY156463335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100290430Medicaid
KY7100290430Medicaid