Provider Demographics
NPI:1275179483
Name:EXCELSIOR FAMILY MEDICINE,LLC
Entity Type:Organization
Organization Name:EXCELSIOR FAMILY MEDICINE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:509-559-3130
Mailing Address - Street 1:9631 N NEVADA ST STE 202
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-1197
Mailing Address - Country:US
Mailing Address - Phone:509-467-1100
Mailing Address - Fax:509-468-0173
Practice Address - Street 1:9631 N NEVADA ST STE 202
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1197
Practice Address - Country:US
Practice Address - Phone:509-467-1100
Practice Address - Fax:509-468-0173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-22
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty