Provider Demographics
NPI:1497057996
Name:EXCELLENCE MEDICAL LEGAL RESEARCH & CONSULTING, LLC
Entity Type:Organization
Organization Name:EXCELLENCE MEDICAL LEGAL RESEARCH & CONSULTING, LLC
Other - Org Name:EXCEL MED DIAGNOSTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:RIDDELL
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BS
Authorized Official - Phone:541-688-0550
Mailing Address - Street 1:2639 DOVER DR
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-1987
Mailing Address - Country:US
Mailing Address - Phone:541-688-0550
Mailing Address - Fax:541-688-0550
Practice Address - Street 1:2639 DOVER DR
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97404-1987
Practice Address - Country:US
Practice Address - Phone:541-688-0550
Practice Address - Fax:541-688-0550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-03
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR099007897RN251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care