Provider Demographics
NPI:1477648152
Name:EXCELA HEALTH PHYSICIAN PRACTICES, INC.
Entity Type:Organization
Organization Name:EXCELA HEALTH PHYSICIAN PRACTICES, INC.
Other - Org Name:EXCELA HEALTH MT VIEW INTERNAL MEDICINE
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 1:800 MARGUERITE RD
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-8555
Practice Address - Country:US
Practice Address - Phone:724-834-2525
Practice Address - Fax:724-834-6171
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EXCELA HEALTH HOLDING COMPANY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-04
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015621860063Medicaid
535978Medicare PIN