Provider Demographics
NPI:1073609236
Name:EXCELA HEALTH PHYSICIAN PRACTICES, INC.
Entity Type:Organization
Organization Name:EXCELA HEALTH PHYSICIAN PRACTICES, INC.
Other - Org Name:EXCELA HEALTH WEST NEWTON FAMILY MEDICINE
Other - Org Type:Other Name
Authorized Official - Title/Position:VP, PHYS SERV & EXEC DIR, EHPP
Authorized Official - Prefix:
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:L
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-830-8500
Mailing Address - Street 1:115 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:WEST NEWTON
Mailing Address - State:PA
Mailing Address - Zip Code:15089-1357
Mailing Address - Country:US
Mailing Address - Phone:724-872-5252
Mailing Address - Fax:724-872-5501
Practice Address - Street 1:115 S 2ND ST
Practice Address - Street 2:
Practice Address - City:WEST NEWTON
Practice Address - State:PA
Practice Address - Zip Code:15089-1357
Practice Address - Country:US
Practice Address - Phone:724-872-5252
Practice Address - Fax:724-872-5501
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EXCELA HEALTH HOLDING COMPANY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-05
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD041300L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015621860069Medicaid
535978Medicare PIN