1578661104 NPI number — EXCELA HEALTH PHYSICIAN PRACTICES, INC.

Table of content: (NPI 1578661104)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578661104 NPI number — EXCELA HEALTH PHYSICIAN PRACTICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EXCELA HEALTH PHYSICIAN PRACTICES, INC.
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:
EXCELA HEALTH BEHAVIORAL HEALTH SERVICES-WESTMORELAND
Provider Other Organization Name Type Code:
5
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:
1578661104
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
134 INDUSTRIAL PARK RD
Provider Second Line Business Mailing Address:
STE 2300A
Provider Business Mailing Address City Name:
GREENSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15601-7328
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-689-1810
Provider Business Mailing Address Fax Number:
724-850-8096

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
532 W PITTSBURGH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15601-2239
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-832-4450
Provider Business Practice Location Address Fax Number:
724-830-6669
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SPHON
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
724-830-8500

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1317129 . This is a "HIGHMARK TRADITIONAL" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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