Provider Demographics
NPI:1386016855
Name:EXCELA HEALTH PHYSICIAN PRACTICES, INC.
Entity Type:Organization
Organization Name:EXCELA HEALTH PHYSICIAN PRACTICES, INC.
Other - Org Name:EXCELA HEALTH SPECIAL CARE NURSERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:M
Authorized Official - Last Name:VARNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-850-6933
Mailing Address - Street 1:134 INDUSTRIAL PARK RD STE 1500
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-8153
Mailing Address - Country:US
Mailing Address - Phone:724-850-6933
Mailing Address - Fax:724-522-4002
Practice Address - Street 1:532 W PITTSBURGH ST
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-2239
Practice Address - Country:US
Practice Address - Phone:724-832-4189
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EXCELA HEALTH HOLDING CO.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-10-23
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001562186Medicaid
PA001562186Medicaid