1689081598 NPI number — EXCEL HEALTH OF CABOT LLC

Table of content: (NPI 1689081598)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689081598 NPI number — EXCEL HEALTH OF CABOT LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EXCEL HEALTH OF CABOT LLC
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:
Provider Other Organization Name Type Code:
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:
1689081598
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/05/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2251 BILL FOSTER MEMORIAL HIGHWAY
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
CABOT
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72023
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-941-3345
Provider Business Mailing Address Fax Number:
501-941-3340

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2251 BILL FOSTER MEMORIAL HWY
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
CABOT
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72023-7200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-941-3345
Provider Business Practice Location Address Fax Number:
501-941-3340
Provider Enumeration Date:
07/14/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RAMASWAMY
Authorized Official First Name:
SRINIVASAN
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
501-847-3292

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  E-4676 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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