Provider Demographics
NPI:1053321315
Name:EXCEL PRIMARY CARE PLLC
Entity Type:Organization
Organization Name:EXCEL PRIMARY CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MEENA
Authorized Official - Middle Name:
Authorized Official - Last Name:VENUGOPAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-507-0604
Mailing Address - Street 1:3303 S LINDSAY RD
Mailing Address - Street 2:#115
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-6503
Mailing Address - Country:US
Mailing Address - Phone:480-507-0604
Mailing Address - Fax:480-507-0592
Practice Address - Street 1:3303 S LINDSAY RD
Practice Address - Street 2:#115
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-6503
Practice Address - Country:US
Practice Address - Phone:480-507-0604
Practice Address - Fax:480-507-0592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30137207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty