Provider Demographics
NPI:1336485838
Name:EXCEL FAMILY MEDICINE & PEDIATRICS CLINIC, INC
Entity Type:Organization
Organization Name:EXCEL FAMILY MEDICINE & PEDIATRICS CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:O
Authorized Official - Last Name:OCHEI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:469-206-2630
Mailing Address - Street 1:2707 BOLTON BOONE DR.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-2019
Mailing Address - Country:US
Mailing Address - Phone:469-206-2630
Mailing Address - Fax:214-730-4281
Practice Address - Street 1:2707 BOLTON BOONE DR.
Practice Address - Street 2:SUITE 100
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2019
Practice Address - Country:US
Practice Address - Phone:469-206-2630
Practice Address - Fax:214-730-4281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-02
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8394207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty