Provider Demographics
NPI:1164517835
Name:EXCELA HEALTH INTERNAL MEDICINE & PEDIATRICS
Entity Type:Organization
Organization Name:EXCELA HEALTH INTERNAL MEDICINE & PEDIATRICS
Other - Org Name:WPHC-DELMONT
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SPHON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-830-8500
Mailing Address - Street 1:421 ROUTE 22
Mailing Address - Street 2:
Mailing Address - City:DELMONT
Mailing Address - State:PA
Mailing Address - Zip Code:15626-1637
Mailing Address - Country:US
Mailing Address - Phone:724-468-8764
Mailing Address - Fax:724-468-8785
Practice Address - Street 1:421 ROUTE 22
Practice Address - Street 2:
Practice Address - City:DELMONT
Practice Address - State:PA
Practice Address - Zip Code:15626-1637
Practice Address - Country:US
Practice Address - Phone:724-468-8764
Practice Address - Fax:724-468-8785
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EXCELA HEALTH PHYSICIAN PRACTICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-04
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD423578207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015621860027Medicaid
535978Medicare PIN