Provider Demographics
NPI:1689081598
Name:EXCEL HEALTH OF CABOT LLC
Entity Type:Organization
Organization Name:EXCEL HEALTH OF CABOT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SRINIVASAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMASWAMY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-847-3292
Mailing Address - Street 1:2251 BILL FOSTER MEMORIAL HIGHWAY
Mailing Address - Street 2:SUITE B
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023
Mailing Address - Country:US
Mailing Address - Phone:501-941-3345
Mailing Address - Fax:501-941-3340
Practice Address - Street 1:2251 BILL FOSTER MEMORIAL HWY
Practice Address - Street 2:SUITE B
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023-7200
Practice Address - Country:US
Practice Address - Phone:501-941-3345
Practice Address - Fax:501-941-3340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-14
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-4676208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty