Provider Demographics
NPI:1538115563
Name:EXCEL INTERNAL MEDICINE, INC.
Entity Type:Organization
Organization Name:EXCEL INTERNAL MEDICINE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:HANSY
Authorized Official - Middle Name:
Authorized Official - Last Name:ODI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-802-6773
Mailing Address - Street 1:513 BROOKWOOD BLVD
Mailing Address - Street 2:SUITE 502
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-6862
Mailing Address - Country:US
Mailing Address - Phone:205-802-6773
Mailing Address - Fax:205-871-9647
Practice Address - Street 1:513 BROOKWOOD BLVD
Practice Address - Street 2:SUITE 502
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-6862
Practice Address - Country:US
Practice Address - Phone:205-802-6773
Practice Address - Fax:205-871-9647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00024167207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALP00086293OtherRAILROAD MEDICARE
AL51518288OtherBCBS OF ALABAMA
ALP00086293OtherRAILROAD MEDICARE