1720251119 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 1720251119 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:
1720251119
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/10/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
520 JEFFERSON AVE
Provider Second Line Business Mailing Address:
ROOM 503
Provider Business Mailing Address City Name:
JEANNETTE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15644-2538
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-527-1544
Provider Business Mailing Address Fax Number:
724-527-5026

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
520 JEFFERSON AVE
Provider Second Line Business Practice Location Address:
ROOM 503
Provider Business Practice Location Address City Name:
JEANNETTE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15644-2538
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-527-1544
Provider Business Practice Location Address Fax Number:
724-527-5026
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: 207Q00000X , with the licence number:  OS009992L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 001562186 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com