Provider Demographics
NPI:1710914049
Name:EXCELTH, INCORPORATED
Entity Type:Organization
Organization Name:EXCELTH, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:ANDRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-524-1210
Mailing Address - Street 1:1515 POYDRAS ST
Mailing Address - Street 2:SUITE 1070
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-3723
Mailing Address - Country:US
Mailing Address - Phone:504-524-1210
Mailing Address - Fax:504-524-1491
Practice Address - Street 1:730 COLONIAL DR STE E
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-6536
Practice Address - Country:US
Practice Address - Phone:225-201-0751
Practice Address - Fax:225-706-0173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1944581Medicaid
LA1441589Medicaid
LA191831Medicare ID - Type UnspecifiedCLINIC PROVIDER NUMBER