1992285860 NPI number — EXCEL HEALTH MD PLLC

Table of content: (NPI 1992285860)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992285860 NPI number — EXCEL HEALTH MD PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EXCEL HEALTH MD PLLC
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:
1992285860
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/20/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
318 W FM 544
Provider Second Line Business Mailing Address:
BLDG C, SUITE#4
Provider Business Mailing Address City Name:
MURPHY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75094
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-752-3199
Provider Business Mailing Address Fax Number:
866-207-3856

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
318 W FM 544
Provider Second Line Business Practice Location Address:
BLDG C, SUITE#4
Provider Business Practice Location Address City Name:
MURPHY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75094
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-752-3199
Provider Business Practice Location Address Fax Number:
866-207-3856
Provider Enumeration Date:
08/20/2018

Additional Information

Authorized Official

Authorized Official Last Name:
RAMAN
Authorized Official First Name:
INDRANI
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
972-752-3199

Provider Taxonomy Codes

  • Taxonomy code: 207RB0002X , with the licence number:  M5457 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1063904415 . This is a "NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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