1184188096 NPI number — EXCELA HEALTH PHYSICIAN PRACTICES, INC..

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184188096 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:
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:
1184188096
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/24/2019
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 STE 1500
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15601-8153
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-850-6933
Provider Business Mailing Address Fax Number:
724-522-4002

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
508 S CHURCH ST STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MT PLEASANT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15666-1702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-423-4051
Provider Business Practice Location Address Fax Number:
724-547-3799
Provider Enumeration Date:
01/24/2019

Additional Information

Authorized Official

Authorized Official Last Name:
VARNEY
Authorized Official First Name:
RENEE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CREDENTIALING COORDINATOR
Authorized Official Telephone Number:
724-850-6933

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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