1639342025 NPI number — EXCELA HEALTH PHYSICIAN PRACTICES, INC.

Table of content: (NPI 1639342025)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639342025 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:
6
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:
1639342025
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/23/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2090 HARRISON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JEANNETTE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15644-1153
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-744-6167
Provider Business Mailing Address Fax Number:
724-744-6070

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2090 HARRISON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JEANNETTE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15644-1153
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-744-6167
Provider Business Practice Location Address Fax Number:
724-744-6070
Provider Enumeration Date:
04/08/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
KIRK
Authorized Official Middle Name:
L
Authorized Official Title or Position:
VP, PHYS SERV & EXEC DIR, EHPP
Authorized Official Telephone Number:
724-830-8500

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0015621860071 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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